pbp_a_hnumber	pbp_a_plan_identifier	segment_id	pbp_a_ben_cov	pbp_a_plan_type	orgtype	bid_id	version	mrx_tier_label_list	mrx_tier_benefit_type	mrx_tier_drug_type	mrx_tier_includes	mrx_tier_cstshr_struct_type	mrx_tier_id	mrx_tier_type_id	mrx_tier_locat_rstd	mrx_tier_locat_rsplt	mrx_tier_locat_oon	mrx_tier_locat_mostd	mrx_tier_locat_mosplt	mrx_tier_locat_ltc	mrx_tier_rstd_1m_num	mrx_tier_rstd_2m_num	mrx_tier_rstd_3m_num	mrx_tier_rsplt_1m_num	mrx_tier_rsplt_2m_num	mrx_tier_rsplt_3m_num	mrx_tier_extd_days_yn	mrx_tier_extd_first_fill	mrx_tier_mostd_1m_num	mrx_tier_mostd_2m_num	mrx_tier_mostd_3m_num	mrx_tier_mosplt_1m_num	mrx_tier_mosplt_2m_num	mrx_tier_mosplt_3m_num	mrx_tier_oonp_1m_num	mrx_tier_oonp_othnumn	mrx_tier_ltcp_1m	mrx_tier_rstd_copay_1m	mrx_tier_rstd_copay_2m	mrx_tier_rstd_copay_3m	mrx_tier_rstd_coins_avg_1m	mrx_tier_rstd_coins_1m	mrx_tier_rstd_coins_2m	mrx_tier_rstd_coins_3m	mrx_tier_rsstd_copay_1m	mrx_tier_rsstd_copay_2m	mrx_tier_rsstd_copay_3m	mrx_tier_rsstd_coins_avg_1m	mrx_tier_rsstd_coins_1m	mrx_tier_rsstd_coins_2m	mrx_tier_rsstd_coins_3m	mrx_tier_rspfd_copay_1m	mrx_tier_rspfd_copay_2m	mrx_tier_rspfd_copay_3m	mrx_tier_rspfd_coins_avg_1m	mrx_tier_rspfd_coins_1m	mrx_tier_rspfd_coins_2m	mrx_tier_rspfd_coins_3m	mrx_tier_mostd_copay_1m	mrx_tier_mostd_copay_2m	mrx_tier_mostd_copay_3m	mrx_tier_mostd_coins_1m	mrx_tier_mostd_coins_2m	mrx_tier_mostd_coins_3m	mrx_tier_mosstd_copay_1m	mrx_tier_mosstd_copay_2m	mrx_tier_mosstd_copay_3m	mrx_tier_mosstd_coins_1m	mrx_tier_mosstd_coins_2m	mrx_tier_mosstd_coins_3m	mrx_tier_mospfd_copay_1m	mrx_tier_mospfd_copay_2m	mrx_tier_mospfd_copay_3m	mrx_tier_mospfd_coins_1m	mrx_tier_mospfd_coins_2m	mrx_tier_mospfd_coins_3m	mrx_tier_oonp_copay_1m	mrx_tier_oonp_copay_othnum	mrx_tier_oonp_coins_1m	mrx_tier_oonp_coins_othnum	mrx_tier_ltcp_copay_1m	mrx_tier_ltcp_coins_1m	mrx_tier_rstd_copay_daily	mrx_tier_rsstd_copay_daily	mrx_tier_rspfd_copay_daily	mrx_tier_mostd_copay_daily	mrx_tier_mosstd_copay_daily	mrx_tier_mospfd_copay_daily	mrx_tier_ltcp_copay_daily	mrx_tier_form_model_desc	mrx_tier_includes_mmp	mrx_tier_copay_amt_rstd_mmpmin	mrx_tier_copay_amt_rstd_mmpmax	mrx_tier_copay_amt_oon_mmpmin	mrx_tier_copay_amt_oon_mmpmax	mrx_tier_copay_amt_mstd_mmpmin	mrx_tier_copay_amt_mstd_mmpmax	mrx_tier_copay_amt_ltc_mmpmin	mrx_tier_copay_amt_ltc_mmpmax	mrx_tier_gap_cost_share	mrx_tier_gap_part_drugs	mrx_tier_gap_part_includes
H0022	001	0	1	48	05	H0022_001_0	10	Generic Drugs	4	010000			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	10	Brand Drugs	4	000010			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	10	Non-Medicare Rx/OTC Drugs	4	010010			3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0028	004	0	1	01	01	H0028_004_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	004	0	1	01	01	H0028_004_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H0028	004	0	1	01	01	H0028_004_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	004	0	1	01	01	H0028_004_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H0028	004	0	1	01	01	H0028_004_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	004	0	1	01	01	H0028_004_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H0028	004	0	1	01	01	H0028_004_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	004	0	1	01	01	H0028_004_0	4	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H0028	004	0	1	01	01	H0028_004_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	004	0	1	01	01	H0028_004_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H0028	007	0	1	01	01	H0028_007_0	5	Preferred Generic	3	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	007	0	1	01	01	H0028_007_0	5	Generic	3	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								9.00		27.00					4.00		12.00											9.00		27.00				4.00		0.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	007	0	1	01	01	H0028_007_0	5	Preferred Brand	3	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	007	0	1	01	01	H0028_007_0	5	Non-Preferred Drug	3	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	007	0	1	01	01	H0028_007_0	5	Specialty Tier	3	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	008	1	1	01	01	H0028_008_1	4	Preferred Generic	4	001010	1	2	1	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												
H0028	008	1	1	01	01	H0028_008_1	4	Preferred Generic	4	001010	1	2	1	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										2	3	
H0028	008	1	1	01	01	H0028_008_1	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	008	1	1	01	01	H0028_008_1	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H0028	008	1	1	01	01	H0028_008_1	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	008	1	1	01	01	H0028_008_1	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H0028	008	1	1	01	01	H0028_008_1	4	Non-Preferred Drug	4	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											72.00	50		50				71.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	008	1	1	01	01	H0028_008_1	4	Non-Preferred Drug	4	110000	1	1	4	3		110	01		110	1				30		90	2	2				30		90	30		31											70.00	31		31				69.00	31		31										31		31				31		31			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H0028	008	1	1	01	01	H0028_008_1	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	008	1	1	01	01	H0028_008_1	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H0028	008	2	1	01	01	H0028_008_2	4	Preferred Generic	4	001010	1	2	1	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												
H0028	008	2	1	01	01	H0028_008_2	4	Preferred Generic	4	001010	1	2	1	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										2	3	
H0028	008	2	1	01	01	H0028_008_2	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	008	2	1	01	01	H0028_008_2	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H0028	008	2	1	01	01	H0028_008_2	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	008	2	1	01	01	H0028_008_2	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H0028	008	2	1	01	01	H0028_008_2	4	Non-Preferred Drug	4	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											72.00	50		50				71.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	008	2	1	01	01	H0028_008_2	4	Non-Preferred Drug	4	110000	1	1	4	3		110	01		110	1				30		90	2	2				30		90	30		31											70.00	31		31				69.00	31		31										31		31				31		31			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H0028	008	2	1	01	01	H0028_008_2	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0028	008	2	1	01	01	H0028_008_2	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H0062	001	0	1	01	01	H0062_001_0	5	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0062	001	0	1	01	01	H0062_001_0	5	Preferred Generic	4	001000	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0062	001	0	1	01	01	H0062_001_0	5	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	14.00	28.00	42.00																			14.00	28.00	42.00																14.00				14.00		0.47			0.47			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0062	001	0	1	01	01	H0062_001_0	5	Preferred Brand	4	010001	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0062	001	0	1	01	01	H0062_001_0	5	Non-Preferred Brand	4	110000	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0062	001	0	1	01	01	H0062_001_0	5	Specialty Tier	4	010010	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 Brand, Specialty Tier, Select Care Drugs												
H0062	001	0	1	01	01	H0062_001_0	5	Select Care Drugs	4	010010	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0062	001	0	1	01	01	H0062_001_0	5	Select Care Drugs	4	010010	1	2	6	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0062	002	0	1	01	01	H0062_002_0	5	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0062	002	0	1	01	01	H0062_002_0	5	Preferred Generic	4	001000	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0062	002	0	1	01	01	H0062_002_0	5	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	14.00	28.00	42.00																			14.00	28.00	42.00																14.00				14.00		0.47			0.47			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0062	002	0	1	01	01	H0062_002_0	5	Preferred Brand	4	010001	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	46.00	92.00	138.00																			46.00	92.00	138.00																46.00				46.00		1.53			1.53			1.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0062	002	0	1	01	01	H0062_002_0	5	Non-Preferred Brand	4	110000	1	2	4	1	111		01	111		1	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, Select Care Drugs												
H0062	002	0	1	01	01	H0062_002_0	5	Specialty Tier	4	010010	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 Brand, Specialty Tier, Select Care Drugs												
H0062	002	0	1	01	01	H0062_002_0	5	Select Care Drugs	4	010010	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0062	002	0	1	01	01	H0062_002_0	5	Select Care Drugs	4	010010	1	2	6	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0062	003	0	1	01	01	H0062_003_0	5	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0062	003	0	1	01	01	H0062_003_0	5	Preferred Generic	4	001000	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0062	003	0	1	01	01	H0062_003_0	5	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	14.00	28.00	42.00																			14.00	28.00	42.00																14.00				14.00		0.47			0.47			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0062	003	0	1	01	01	H0062_003_0	5	Preferred Brand	4	010001	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	46.00	92.00	138.00																			46.00	92.00	138.00																46.00				46.00		1.53			1.53			1.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0062	003	0	1	01	01	H0062_003_0	5	Non-Preferred Brand	4	110000	1	2	4	1	111		01	111		1	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, Select Care Drugs												
H0062	003	0	1	01	01	H0062_003_0	5	Specialty Tier	4	010010	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 Brand, Specialty Tier, Select Care Drugs												
H0062	003	0	1	01	01	H0062_003_0	5	Select Care Drugs	4	010010	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0062	003	0	1	01	01	H0062_003_0	5	Select Care Drugs	4	010010	1	2	6	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0104	012	0	1	04	01	H0104_012_0	6	Preferred Generic	4	001000	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								4.00		12.00					4.00		8.00					4.00		8.00																4.00				4.00			0.13	0.13	0.13			0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0104	012	0	1	04	01	H0104_012_0	6	Generic	4	010000	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								20.00		60.00					20.00		40.00					20.00		40.00																20.00				20.00			0.66	0.66	0.66			0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0104	012	0	1	04	01	H0104_012_0	6	Preferred Brand	4	010001	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		94.00																47.00				47.00			1.56	1.56	1.56			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0104	012	0	1	04	01	H0104_012_0	6	Non-Preferred Brand	4	110000	1	1	4	1		110	01	110		1				30		90	1	2	30		90				30		31											52.07	50		50				52.07	50		50				50		50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0104	012	0	1	04	01	H0104_012_0	6	Specialty Tier	4	010010	1	1	5	1		110	01	110		1				30		90	1	2	30		90				30		31											1.00	25		25				1.00	25		25				25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0104	012	0	1	04	01	H0104_012_0	6	Select Care Drugs	4	010000	1	2	6	1		110	01	110		1				30		90	1	2	30		90				30		31								2.00		6.00					2.00		4.00					2.00		4.00																2.00				2.00			0.06	0.06	0.06			.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0104	013	0	1	04	01	H0104_013_0	6	Preferred Generic	4	001000	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								4.00		12.00					4.00		8.00					4.00		8.00																4.00				4.00			0.13	0.13	0.13			0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0104	013	0	1	04	01	H0104_013_0	6	Generic	4	010000	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								20.00		60.00					20.00		40.00					20.00		40.00																20.00				20.00			0.66	0.66	0.66			0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0104	013	0	1	04	01	H0104_013_0	6	Preferred Brand	4	010001	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		94.00																47.00				47.00			1.56	1.56	1.56			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0104	013	0	1	04	01	H0104_013_0	6	Non-Preferred Brand	4	110000	1	1	4	1		110	01	110		1				30		90	1	2	30		90				30		31											47.86	50		50				47.86	50		50				50		50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0104	013	0	1	04	01	H0104_013_0	6	Specialty Tier	4	010010	1	1	5	1		110	01	110		1				30		90	1	2	30		90				30		31											1.00	25		25				1.00	25		25				25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0104	013	0	1	04	01	H0104_013_0	6	Select Care Drugs	4	010000	1	2	6	1		110	01	110		1				30		90	1	2	30		90				30		31								2.00		6.00					2.00		4.00					2.00		4.00																2.00				2.00			0.06	0.06	0.06			.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0104	014	0	1	04	01	H0104_014_0	6	Preferred Generic	4	001000	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								4.00		12.00					4.00		8.00					4.00		8.00																4.00				4.00			0.13	0.13	0.13			0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0104	014	0	1	04	01	H0104_014_0	6	Generic	4	010000	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								20.00		60.00					20.00		40.00					20.00		40.00																20.00				20.00			0.66	0.66	0.66			0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0104	014	0	1	04	01	H0104_014_0	6	Preferred Brand	4	010001	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		94.00																47.00				47.00			1.56	1.56	1.56			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0104	014	0	1	04	01	H0104_014_0	6	Non-Preferred Brand	4	110000	1	1	4	1		110	01	110		1				30		90	1	2	30		90				30		31											59.03	50		50				59.03	50		50				50		50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0104	014	0	1	04	01	H0104_014_0	6	Specialty Tier	4	010010	1	1	5	1		110	01	110		1				30		90	1	2	30		90				30		31											1.00	25		25				1.00	25		25				25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0104	014	0	1	04	01	H0104_014_0	6	Select Care Drugs	4	010000	1	2	6	1		110	01	110		1				30		90	1	2	30		90				30		31								2.00		6.00					2.00		4.00					2.00		4.00																2.00				2.00			0.06	0.06	0.06			.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0104	015	0	1	04	01	H0104_015_0	5	Preferred Generic	4	001000	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								4.00		12.00					4.00		8.00					4.00		8.00																4.00				4.00			0.13	0.13	0.13			0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0104	015	0	1	04	01	H0104_015_0	5	Generic	4	010000	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		24.00																12.00				12.00			0.40	0.40	0.40			0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0104	015	0	1	04	01	H0104_015_0	5	Preferred Brand	4	010001	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		94.00																47.00				47.00			1.56	1.56	1.56			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0104	015	0	1	04	01	H0104_015_0	5	Non-Preferred Brand	4	110000	1	1	4	1		110	01	110		1				30		90	1	2	30		90				30		31											51.14	50		50				51.14	50		50				50		50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0104	015	0	1	04	01	H0104_015_0	5	Specialty Tier	4	010010	1	1	5	1		110	01	110		1				30		90	1	2	30		90				30		31											1.00	33		33				1.00	33		33				33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0104	015	0	1	04	01	H0104_015_0	5	Select Care Drugs	4	010000	1	2	6	1		110	01	110		1				30		90	1	2	30		90				30		31								2.00		6.00					2.00		4.00					2.00		4.00																2.00				2.00			0.06	0.06	0.06			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0107	001	0	1	04	01	H0107_001_0	7	Preferred Generic	4	001000	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							27.00																9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0107	001	0	1	04	01	H0107_001_0	7	Preferred Generic	4	001000	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							27.00																9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0107	001	0	1	04	01	H0107_001_0	7	Generic	4	010010	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								15.00		45.00					6.00		18.00							45.00																15.00				15.00			0.50	0.20				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0107	001	0	1	04	01	H0107_001_0	7	Generic	4	010010	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								15.00		45.00					6.00		18.00							45.00																15.00				15.00			0.50	0.20				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0107	001	0	1	04	01	H0107_001_0	7	Preferred Brand	4	010001	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					39.00		117.00							141.00																47.00				47.00			1.57	1.30				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0107	001	0	1	04	01	H0107_001_0	7	Non-Preferred Brand	4	110000	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								99.00		297.00					85.00		255.00							297.00																99.00				99.00			3.30	2.83				3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0107	001	0	1	04	01	H0107_001_0	7	Specialty Tier	4	010010	1	1	5	1		110	01	100		1				30		90	1	2			90				30		31											693.33	33		33				694.36	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0107	002	0	1	04	01	H0107_002_0	7	Preferred Generic	4	001000	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							27.00																9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0107	002	0	1	04	01	H0107_002_0	7	Preferred Generic	4	001000	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							27.00																9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0107	002	0	1	04	01	H0107_002_0	7	Generic	4	010010	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								15.00		45.00					6.00		18.00							45.00																15.00				15.00			0.50	0.20				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0107	002	0	1	04	01	H0107_002_0	7	Generic	4	010010	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								15.00		45.00					6.00		18.00							45.00																15.00				15.00			0.50	0.20				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0107	002	0	1	04	01	H0107_002_0	7	Preferred Brand	4	010001	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					39.00		117.00							141.00																47.00				47.00			1.57	1.30				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0107	002	0	1	04	01	H0107_002_0	7	Non-Preferred Brand	4	110000	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								99.00		297.00					85.00		255.00							297.00																99.00				99.00			3.30	2.83				3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0107	002	0	1	04	01	H0107_002_0	7	Specialty Tier	4	010010	1	1	5	1		110	01	100		1				30		90	1	2			90				30		31											657.52	33		33				658.47	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0137	001	0	1	48	05	H0137_001_0	5	Generic Drugs	4	010000			1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31																																																					Generic Drugs, Preferred Brand Drugs, Non-Preferred Brand Drugs	3	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0137	001	0	1	48	05	H0137_001_0	5	Preferred Brand Drugs	4	000001			2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31																																																					Generic Drugs, Preferred Brand Drugs, Non-Preferred Brand Drugs	3	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0137	001	0	1	48	05	H0137_001_0	5	Non-Preferred Brand Drugs	4	100000			3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31																																																					Generic Drugs, Preferred Brand Drugs, Non-Preferred Brand Drugs	3	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0141	004	1	1	01	01	H0141_004_1	12	Generic	4	010000	1	2	1	1	111		01			1	30	60	90				1	2							30		31	5.00	10.00	11.25																																					5.00				5.00		0.17						0.16	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0141	004	1	1	01	01	H0141_004_1	12	Preferred Brand	4	000001	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	35.00	70.00	78.75																					78.75																35.00				35.00		1.17						1.13	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0141	004	1	1	01	01	H0141_004_1	12	Non-Preferred Brand	4	100000	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	85.00	170.00	191.25																					191.25																85.00				85.00		2.83						2.74	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0141	004	1	1	01	01	H0141_004_1	12	Specialty Tier	4	000010	1	1	4	1	010		01	010		1	30								30						30		31					29																				29																	29			29								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0141	004	2	1	01	01	H0141_004_2	12	Generic	4	010000	1	2	1	1	111		01			1	30	60	90				1	2							30		31	5.00	10.00	11.25																																					5.00				5.00		0.17						0.16	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0141	004	2	1	01	01	H0141_004_2	12	Preferred Brand	4	000001	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	35.00	70.00	78.75																					78.75																35.00				35.00		1.17						1.13	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0141	004	2	1	01	01	H0141_004_2	12	Non-Preferred Brand	4	100000	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	85.00	170.00	191.25																					191.25																85.00				85.00		2.83						2.74	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0141	004	2	1	01	01	H0141_004_2	12	Specialty Tier	4	000010	1	1	4	1	010		01	010		1	30								30						30		31					29																				29																	29			29								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0141	005	1	1	01	01	H0141_005_1	12	Generic	4	010000	1	2	1	1	111		01			1	30	60	90				1	2							30		31	5.00	10.00	11.25																																					5.00				5.00		0.17						0.16	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0141	005	1	1	01	01	H0141_005_1	12	Preferred Brand	4	000001	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	35.00	70.00	78.75																					78.75																35.00				35.00		1.17						1.13	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0141	005	1	1	01	01	H0141_005_1	12	Non-Preferred Brand	4	100000	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	85.00	170.00	191.25																					191.25																85.00				85.00		2.83						2.74	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0141	005	1	1	01	01	H0141_005_1	12	Specialty Tier	4	000010	1	1	4	1	010		01	010		1	30								30						30		31					29																				29																	29			29								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0141	005	3	1	01	01	H0141_005_3	12	Generic	4	010000	1	2	1	1	111		01			1	30	60	90				1	2							30		31	5.00	10.00	11.25																																					5.00				5.00		0.17						0.16	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0141	005	3	1	01	01	H0141_005_3	12	Preferred Brand	4	000001	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	35.00	70.00	78.75																					78.75																35.00				35.00		1.17						1.13	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0141	005	3	1	01	01	H0141_005_3	12	Non-Preferred Brand	4	100000	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	85.00	170.00	191.25																					191.25																85.00				85.00		2.83						2.74	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0141	005	3	1	01	01	H0141_005_3	12	Specialty Tier	4	000010	1	1	4	1	010		01	010		1	30								30						30		31					29																				29																	29			29								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0141	006	1	1	01	01	H0141_006_1	12	Generic	4	010000	1	2	1	1	111		01			1	30	60	90				1	2							30		31	5.00	10.00	11.25																																					5.00				5.00		0.17						0.16	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0141	006	1	1	01	01	H0141_006_1	12	Preferred Brand	4	000001	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	35.00	70.00	78.75																					78.75																35.00				35.00		1.17						1.13	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0141	006	1	1	01	01	H0141_006_1	12	Non-Preferred Brand	4	100000	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	85.00	170.00	191.25																					191.25																85.00				85.00		2.83						2.74	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0141	006	1	1	01	01	H0141_006_1	12	Specialty Tier	4	000010	1	1	4	1	010		01	010		1	30								30						30		31					29																				29																	29			29								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0141	006	2	1	01	01	H0141_006_2	12	Generic	4	010000	1	2	1	1	111		01			1	30	60	90				1	2							30		31	5.00	10.00	11.25																																					5.00				5.00		0.17						0.16	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0141	006	2	1	01	01	H0141_006_2	12	Preferred Brand	4	000001	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	35.00	70.00	78.75																					78.75																35.00				35.00		1.17						1.13	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0141	006	2	1	01	01	H0141_006_2	12	Non-Preferred Brand	4	100000	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	85.00	170.00	191.25																					191.25																85.00				85.00		2.83						2.74	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0141	006	2	1	01	01	H0141_006_2	12	Specialty Tier	4	000010	1	1	4	1	010		01	010		1	30								30						30		31					29																				29																	29			29								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0147	001	0	1	48	05	H0147_001_0	4	Generic Drugs	4	010010			1	1	111		10	111		1	31	62	93				2	2	31	62	93					10	31																																														0.00			0.00			0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0147	001	0	1	48	05	H0147_001_0	4	Brand Drugs	4	010010			2	1	111		10	111		1	31	62	93				2	1	31	62	93					10	31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	0.00	8.25			0.00	8.25	0.00	8.25			
H0147	001	0	1	48	05	H0147_001_0	4	Non-Medicare Rx Drugs	4	010000			3	1	010		10			1	31															10	31																																														0.00						0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	2	0.00	0.00	0.00	0.00			0.00	0.00			
H0147	001	0	1	48	05	H0147_001_0	4	Non-Medicare OTC Drugs	4	010000			4	1	010		10			1	31															10	31																																														0.00						0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	2	0.00	0.00	0.00	0.00			0.00	0.00			
H0148	001	0	1	48	05	H0148_001_0	7	Generic Drugs	4	010000			1	1	110		10	100		1	30		90				2	2			90					10	31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	3.30					0.00	3.30			
H0148	001	0	1	48	05	H0148_001_0	7	Brand Drugs	4	000010			2	1	110		10	100		1	30		90				2	2			90					10	31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	8.25					0.00	8.25			
H0148	001	0	1	48	05	H0148_001_0	7	Non-Medicare Rx/OTC Drugs	4	010010			3	1	010		10			1	30															10	31																																														0.00						0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00			0.00	0.00			
H0148	002	0	1	48	05	H0148_002_0	7	Generic Drugs	4	010000			1	1	110		10	100		1	30		90				2	2			90					10	31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	3.30					0.00	3.30			
H0148	002	0	1	48	05	H0148_002_0	7	Brand Drugs	4	000010			2	1	110		10	100		1	30		90				2	2			90					10	31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	8.25					0.00	8.25			
H0148	002	0	1	48	05	H0148_002_0	7	Non-Medicare Rx/OTC Drugs	4	010010			3	1	010		10			1	30															10	31																																														0.00						0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00			0.00	0.00			
H0150	024	1	1	01	01	H0150_024_1	5	Preferred Generic	4	001000	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		31								6.00	12.00	6.00					1.00	2.00	1.00					6.00		6.00																6.00				6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0150	024	1	1	01	01	H0150_024_1	5	Preferred Generic	4	001000	1	2	1	3		111	01	110		1				30	60	90	1	2	30		90				30		31								6.00	12.00	6.00					1.00	2.00	1.00					6.00		6.00																6.00				6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0150	024	1	1	01	01	H0150_024_1	5	Generic	4	010000	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		31								12.00	24.00	12.00					7.00	14.00	7.00					12.00		12.00																12.00				12.00			0.40	0.23	0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0150	024	1	1	01	01	H0150_024_1	5	Generic	4	010000	1	2	2	3		111	01	110		1				30	60	90	1	2	30		90				30		31								12.00	24.00	12.00					7.00	14.00	7.00					12.00		12.00																12.00				12.00			0.40	0.23	0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0150	024	1	1	01	01	H0150_024_1	5	Preferred Brand	4	000101	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		31								45.00	90.00	135.00					40.00	80.00	120.00					45.00		135.00																45.00				45.00			1.50	1.33	1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0150	024	1	1	01	01	H0150_024_1	5	Non-Preferred Drug	4	100100	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		31								95.00	190.00	285.00					90.00	180.00	270.00					95.00		285.00																95.00				95.00			3.17	3.00	3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0150	024	1	1	01	01	H0150_024_1	5	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		31											581.30	31						434.99	31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0150	024	2	1	01	01	H0150_024_2	5	Preferred Generic	4	001000	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		31								6.00	12.00	6.00					1.00	2.00	1.00					6.00		6.00																6.00				6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0150	024	2	1	01	01	H0150_024_2	5	Preferred Generic	4	001000	1	2	1	3		111	01	110		1				30	60	90	1	2	30		90				30		31								6.00	12.00	6.00					1.00	2.00	1.00					6.00		6.00																6.00				6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0150	024	2	1	01	01	H0150_024_2	5	Generic	4	010000	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		31								12.00	24.00	12.00					7.00	14.00	7.00					12.00		12.00																12.00				12.00			0.40	0.23	0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0150	024	2	1	01	01	H0150_024_2	5	Generic	4	010000	1	2	2	3		111	01	110		1				30	60	90	1	2	30		90				30		31								12.00	24.00	12.00					7.00	14.00	7.00					12.00		12.00																12.00				12.00			0.40	0.23	0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0150	024	2	1	01	01	H0150_024_2	5	Preferred Brand	4	000101	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		31								45.00	90.00	135.00					40.00	80.00	120.00					45.00		135.00																45.00				45.00			1.50	1.33	1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0150	024	2	1	01	01	H0150_024_2	5	Non-Preferred Drug	4	100100	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		31								95.00	190.00	285.00					90.00	180.00	270.00					95.00		285.00																95.00				95.00			3.17	3.00	3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0150	024	2	1	01	01	H0150_024_2	5	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		31											581.30	31						434.99	31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0150	025	0	1	02	01	H0150_025_0	6	Preferred Generic	4	001000	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		31								5.00	10.00	10.00					0.00	0.00	0.00					5.00		10.00																5.00				5.00			0.17	0.00	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0150	025	0	1	02	01	H0150_025_0	6	Preferred Generic	4	001000	1	2	1	3		111	01	110		1				30	60	90	1	2	30		90				30		31								5.00	10.00	10.00					0.00	0.00	0.00					5.00		10.00																5.00				5.00			0.17	0.00	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0150	025	0	1	02	01	H0150_025_0	6	Generic	4	010000	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		31								12.00	24.00	24.00					6.00	12.00	12.00					12.00		24.00																12.00				12.00			0.40	0.20	0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0150	025	0	1	02	01	H0150_025_0	6	Generic	4	010000	1	2	2	3		111	01	110		1				30	60	90	1	2	30		90				30		31								12.00	24.00	24.00					6.00	12.00	12.00					12.00		24.00																12.00				12.00			0.40	0.20	0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0150	025	0	1	02	01	H0150_025_0	6	Preferred Brand	4	000101	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		31								45.00	90.00	135.00					40.00	80.00	120.00					45.00		135.00																45.00				45.00			1.50	1.33	1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0150	025	0	1	02	01	H0150_025_0	6	Non-Preferred Drug	4	100100	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		31								85.00	170.00	255.00					80.00	160.00	240.00					85.00		255.00																85.00				85.00			2.83	2.67	2.83			2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0150	025	0	1	02	01	H0150_025_0	6	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		31											632.11	33						474.85	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0154	011	0	1	01	01	H0154_011_0	6	Preferred Generic	4	001000	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	Preferred Generic	4	001000	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								4.00	8.00	12.00					0.00	0.00	0.00											4.00	8.00	12.00				0.00	0.00	0.00				4.00				4.00			0.13	0.00		0.13	0.00	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0154	011	0	1	01	01	H0154_011_0	6	Generic	4	010001	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	30.00				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	011	0	1	01	01	H0154_011_0	6	Preferred Brand	4	000101	1	2	3	1		111	01		111	1				30	60	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	117.50				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	100100	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											80.42	50	50	50				80.42	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0154	011	0	1	01	01	H0154_011_0	6	Specialty Tier	4	010010	1	1	5	1		010	01			1				30											30		31											1.00	33						1.00	33																							33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0154	012	0	1	01	01	H0154_012_0	6	Preferred Generic	3	001000	1	1	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0154	012	0	1	01	01	H0154_012_0	6	Generic	3	010001	1	1	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0154	012	0	1	01	01	H0154_012_0	6	Preferred Brand	3	000101	1	1	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0154	012	0	1	01	01	H0154_012_0	6	Non-Preferred Drug	3	100100	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0154	012	0	1	01	01	H0154_012_0	6	Specialty Tier	3	010010	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	5	Preferred Generic	4	001000	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								4.00	8.00	12.00					0.00	0.00	0.00											4.00	8.00	12.00				0.00	0.00	0.00				4.00				4.00			0.13	0.00		0.13	0.00	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0154	014	0	1	01	01	H0154_014_0	5	Generic	4	010001	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	30.00				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	5	Preferred Brand	4	000101	1	2	3	1		111	01		111	1				30	60	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	117.50				47.00				47.00			1.57	1.57		1.57	1.32	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0154	014	0	1	01	01	H0154_014_0	5	Non-Preferred Drug	4	100100	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											71.34	50	50	50				71.34	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0154	014	0	1	01	01	H0154_014_0	5	Specialty Tier	4	010010	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	5	Preferred Generic	4	001000	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	5	Generic	4	010001	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					15.00	30.00	45.00											15.00	30.00	45.00				12.50	25.00	37.50				15.00				15.00			0.50	0.50		0.50	0.42	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0154	015	1	1	01	01	H0154_015_1	5	Preferred Brand	4	000101	1	2	3	1		111	01		111	1				30	60	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	117.50				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	5	Non-Preferred Drug	4	100100	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											89.18	50	50	50				89.18	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0154	015	1	1	01	01	H0154_015_1	5	Specialty Tier	4	010010	1	1	5	1		010	01			1				30											30		31											1.00	29						1.00	29																							29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0154	015	2	1	01	01	H0154_015_2	5	Preferred Generic	4	001000	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	5	Generic	4	010001	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					15.00	30.00	45.00											15.00	30.00	45.00				12.50	25.00	37.50				15.00				15.00			0.50	0.50		0.50	0.42	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0154	015	2	1	01	01	H0154_015_2	5	Preferred Brand	4	000101	1	2	3	1		111	01		111	1				30	60	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	117.50				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	5	Non-Preferred Drug	4	100100	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											89.18	50	50	50				89.18	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0154	015	2	1	01	01	H0154_015_2	5	Specialty Tier	4	010010	1	1	5	1		010	01			1				30											30		31											1.00	29						1.00	29																							29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0192	001	0	1	48	05	H0192_001_0	3	Generic Drugs	4	010000			1	1	110		01	100		1	30		90				1	2			90				30		31																																														0.00						0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0192	001	0	1	48	05	H0192_001_0	3	Brand Drugs	4	000010			2	1	110		01	100		1	30		90				1	2			90				30		31																																														0.00						0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0192	001	0	1	48	05	H0192_001_0	3	Non-Medicare Rx/OTC Drugs	4	000010			3	1	110		01	100		1	30		90				1	2			90				30		31																																														0.00						0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0281	001	0	1	48	05	H0281_001_0	4	Generic Drugs	4	010000			1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0281	001	0	1	48	05	H0281_001_0	4	Brand Drugs	4	000010			2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0281	001	0	1	48	05	H0281_001_0	4	Non-Medicare Rx/OTC Drugs	4	010010			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			
H0294	002	0	1	04	01	H0294_002_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	002	0	1	04	01	H0294_002_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		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	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		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	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		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	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				1098.00	26		26																										26						26			26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	004	0	1	04	01	H0294_004_0	4	Preferred Generic	3	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	004	0	1	04	01	H0294_004_0	4	Generic	3	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0294	004	0	1	04	01	H0294_004_0	4	Preferred Brand	3	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		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	4	Non-Preferred Drug	3	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		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	4	Specialty Tier	3	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				529.00	25		25																										25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0302	001	0	1	01	01	H0302_001_0	5	Preferred Generic	4	001000	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	2.00	4.00	6.00																					6.00																2.00				2.00		0.07						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0302	001	0	1	01	01	H0302_001_0	5	Generic	4	010000	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					30.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0302	001	0	1	01	01	H0302_001_0	5	Generic	4	010000	1	2	2	3	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					30.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H0302	001	0	1	01	01	H0302_001_0	5	Preferred Brand	4	000001	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	40.00	80.00	120.00																					120.00																40.00				40.00		1.33						1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0302	001	0	1	01	01	H0302_001_0	5	Preferred Brand	4	000001	1	2	3	3	111		01	100		1	30	60	90				1	2			90				30		31	40.00	80.00	120.00																					120.00																40.00				40.00		1.33						1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H0302	001	0	1	01	01	H0302_001_0	5	Non-Preferred Brand	4	100000	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	90.00	180.00	270.00																					270.00																90.00				90.00		3.00						2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0302	001	0	1	01	01	H0302_001_0	5	Specialty Tier	4	010010	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0302	006	0	1	01	01	H0302_006_0	5	Preferred Generic	4	001000	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	2.00	4.00	6.00																					6.00																2.00				2.00		0.07						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0302	006	0	1	01	01	H0302_006_0	5	Generic	4	010000	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					30.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0302	006	0	1	01	01	H0302_006_0	5	Generic	4	010000	1	2	2	3	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					30.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H0302	006	0	1	01	01	H0302_006_0	5	Preferred Brand	4	000001	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												
H0302	006	0	1	01	01	H0302_006_0	5	Preferred Brand	4	000001	1	2	3	3	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										2		
H0302	006	0	1	01	01	H0302_006_0	5	Non-Preferred Brand	4	100000	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	95.00	190.00	285.00																					285.00																95.00				95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0302	006	0	1	01	01	H0302_006_0	5	Specialty Tier	4	010010	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0302	008	0	1	01	01	H0302_008_0	5	Preferred Generic	4	001000	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	2.00	4.00	6.00																					6.00																2.00				2.00		0.07						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0302	008	0	1	01	01	H0302_008_0	5	Generic	4	010000	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					30.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0302	008	0	1	01	01	H0302_008_0	5	Generic	4	010000	1	2	2	3	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					30.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H0302	008	0	1	01	01	H0302_008_0	5	Preferred Brand	4	000001	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												
H0302	008	0	1	01	01	H0302_008_0	5	Preferred Brand	4	000001	1	2	3	3	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										2		
H0302	008	0	1	01	01	H0302_008_0	5	Non-Preferred Brand	4	100000	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	95.00	190.00	285.00																					285.00																95.00				95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0302	008	0	1	01	01	H0302_008_0	5	Specialty Tier	4	010010	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0332	002	0	1	01	01	H0332_002_0	7	Preferred Generic	4	001000	1	2	1	1		110	01			1				30		90	1	2							30		31								8.00		24.00					3.00		7.50																							8.00				8.00			0.27	0.10				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0332	002	0	1	01	01	H0332_002_0	7	Preferred Generic	4	001000	1	2	1	3		110	01			1				30		90	1	2							30		31								8.00		24.00					3.00		7.50																							8.00				8.00			0.27	0.10				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0332	002	0	1	01	01	H0332_002_0	7	Generic	4	010000	1	2	2	1		110	01			1				30		90	1	2							30		31								20.00		60.00					17.00		42.50																							20.00				20.00			0.67	0.57				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0332	002	0	1	01	01	H0332_002_0	7	Preferred Brand	4	000001	1	2	3	1		110	01			1				30		90	1	2							30		31								45.00		135.00					40.00		100.00																							45.00				45.00			1.50	1.33				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0332	002	0	1	01	01	H0332_002_0	7	Non-Preferred Brand	4	100000	1	2	4	1		110	01			1				30		90	1	2							30		31								70.00		210.00					60.00		150.00																							70.00				70.00			2.33	2.00				2.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0332	002	0	1	01	01	H0332_002_0	7	Specialty Tier	4	010010	1	1	5	1		110	01			1				30		90	1	2							30		31												31		31					31		31																					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0332	004	0	1	02	01	H0332_004_0	7	Preferred Generic	4	001000	1	2	1	1		110	01			1				30		90	1	2							30		31								8.00		24.00					3.00		7.50																							8.00				8.00			0.27	0.10				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0332	004	0	1	02	01	H0332_004_0	7	Preferred Generic	4	001000	1	2	1	3		110	01			1				30		90	1	2							30		31								8.00		24.00					3.00		7.50																							8.00				8.00			0.27	0.10				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0332	004	0	1	02	01	H0332_004_0	7	Generic	4	010000	1	2	2	1		110	01			1				30		90	1	2							30		31								20.00		60.00					17.00		42.50																							20.00				20.00			0.67	0.57				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0332	004	0	1	02	01	H0332_004_0	7	Preferred Brand	4	000001	1	2	3	1		110	01			1				30		90	1	2							30		31								45.00		135.00					40.00		100.00																							45.00				45.00			1.50	1.33				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0332	004	0	1	02	01	H0332_004_0	7	Non-Preferred Brand	4	100000	1	2	4	1		110	01			1				30		90	1	2							30		31								70.00		210.00					60.00		150.00																							70.00				70.00			2.33	2.00				2.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0332	004	0	1	02	01	H0332_004_0	7	Specialty Tier	4	010010	1	1	5	1		110	01			1				30		90	1	2							30		31												31		31					31		31																					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0336	001	0	1	48	05	H0336_001_0	4	Generic Drugs	4	010000			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	4	Brand Drugs	4	000010			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	4	Non-Medicare Rx Drugs	4	010010			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	4	Non-Medicare OTC Drugs	4	010010			4	1	110		01	110		1	30		90				1	2	30		90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0351	029	0	1	01	01	H0351_029_0	4	Preferred Generic	3	001000	1	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	029	0	1	01	01	H0351_029_0	4	Generic	3	010000	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	57.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	029	0	1	01	01	H0351_029_0	4	Preferred Brand	3	010001	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	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	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	029	0	1	01	01	H0351_029_0	4	Non-Preferred Brand	3	110000	1	2	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	100.00	200.00	300.00																									100.00	200.00	300.00				100.00	200.00	290.00				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												
H0351	029	0	1	01	01	H0351_029_0	4	Specialty Tier	3	010010	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 Brand, Specialty Tier, Select Care Drugs												
H0351	029	0	1	01	01	H0351_029_0	4	Select Care Drugs	3	010010	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	038	0	1	01	01	H0351_038_0	4	Preferred Generic	4	001000	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	12.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	038	0	1	01	01	H0351_038_0	4	Generic	4	010000	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	42.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	038	0	1	01	01	H0351_038_0	4	Preferred Brand	4	010001	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	101.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	038	0	1	01	01	H0351_038_0	4	Non-Preferred Brand	4	110000	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	260.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	038	0	1	01	01	H0351_038_0	4	Specialty Tier	4	010010	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												33	33	33					33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	038	0	1	01	01	H0351_038_0	4	Select Care Drugs	4	010010	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	040	0	1	01	01	H0351_040_0	4	Preferred Generic	4	001000	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	12.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	040	0	1	01	01	H0351_040_0	4	Generic	4	010000	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	42.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	040	0	1	01	01	H0351_040_0	4	Preferred Brand	4	010001	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	101.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	040	0	1	01	01	H0351_040_0	4	Non-Preferred Brand	4	110000	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	260.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	040	0	1	01	01	H0351_040_0	4	Specialty Tier	4	010010	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												33	33	33					33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	040	0	1	01	01	H0351_040_0	4	Select Care Drugs	4	010010	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	041	0	1	01	01	H0351_041_0	4	Preferred Generic	4	001000	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 Brand, Specialty Tier, Select Care Drugs												
H0351	041	0	1	01	01	H0351_041_0	4	Generic	4	010000	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	33.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	041	0	1	01	01	H0351_041_0	4	Preferred Brand	4	010001	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	101.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	041	0	1	01	01	H0351_041_0	4	Non-Preferred Brand	4	110000	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	260.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	041	0	1	01	01	H0351_041_0	4	Specialty Tier	4	010010	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												33	33	33					33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	041	0	1	01	01	H0351_041_0	4	Select Care Drugs	4	010010	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	042	0	1	01	01	H0351_042_0	4	Preferred Generic	4	001000	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	12.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	042	0	1	01	01	H0351_042_0	4	Generic	4	010000	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	42.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	042	0	1	01	01	H0351_042_0	4	Preferred Brand	4	010001	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	101.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	042	0	1	01	01	H0351_042_0	4	Non-Preferred Brand	4	110000	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	260.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	042	0	1	01	01	H0351_042_0	4	Specialty Tier	4	010010	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												33	33	33					33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	042	0	1	01	01	H0351_042_0	4	Select Care Drugs	4	010010	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	043	1	1	01	01	H0351_043_1	4	Preferred Generic	4	001000	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 Brand, Specialty Tier, Select Care Drugs												
H0351	043	1	1	01	01	H0351_043_1	4	Generic	4	010000	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	42.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	043	1	1	01	01	H0351_043_1	4	Preferred Brand	4	010001	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	101.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	043	1	1	01	01	H0351_043_1	4	Non-Preferred Brand	4	110000	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	260.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	043	1	1	01	01	H0351_043_1	4	Specialty Tier	4	010010	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												33	33	33					33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	043	1	1	01	01	H0351_043_1	4	Select Care Drugs	4	010010	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	043	4	1	01	01	H0351_043_4	7	Preferred Generic	4	001000	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 Brand, Specialty Tier, Select Care Drugs												
H0351	043	4	1	01	01	H0351_043_4	7	Generic	4	010000	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	42.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	043	4	1	01	01	H0351_043_4	7	Preferred Brand	4	010001	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	101.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	043	4	1	01	01	H0351_043_4	7	Non-Preferred Brand	4	110000	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	260.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	043	4	1	01	01	H0351_043_4	7	Specialty Tier	4	010010	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												33	33	33					33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	043	4	1	01	01	H0351_043_4	7	Select Care Drugs	4	010010	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	044	1	1	01	01	H0351_044_1	4	Preferred Generic	4	001000	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 Brand, Specialty Tier, Select Care Drugs												
H0351	044	1	1	01	01	H0351_044_1	4	Generic	4	010000	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	42.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	044	1	1	01	01	H0351_044_1	4	Preferred Brand	4	010001	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	101.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	044	1	1	01	01	H0351_044_1	4	Non-Preferred Brand	4	110000	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	260.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	044	1	1	01	01	H0351_044_1	4	Specialty Tier	4	010010	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												32	32	32					32	32	32										32	32	32				32	32	32			32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	044	1	1	01	01	H0351_044_1	4	Select Care Drugs	4	010010	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	044	2	1	01	01	H0351_044_2	4	Preferred Generic	4	001000	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 Brand, Specialty Tier, Select Care Drugs												
H0351	044	2	1	01	01	H0351_044_2	4	Generic	4	010000	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	42.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	044	2	1	01	01	H0351_044_2	4	Preferred Brand	4	010001	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	101.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	044	2	1	01	01	H0351_044_2	4	Non-Preferred Brand	4	110000	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	260.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	044	2	1	01	01	H0351_044_2	4	Specialty Tier	4	010010	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												32	32	32					32	32	32										32	32	32				32	32	32			32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	044	2	1	01	01	H0351_044_2	4	Select Care Drugs	4	010010	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	044	3	1	01	01	H0351_044_3	4	Preferred Generic	4	001000	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 Brand, Specialty Tier, Select Care Drugs												
H0351	044	3	1	01	01	H0351_044_3	4	Generic	4	010000	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	42.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	044	3	1	01	01	H0351_044_3	4	Preferred Brand	4	010001	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	101.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	044	3	1	01	01	H0351_044_3	4	Non-Preferred Brand	4	110000	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	260.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	044	3	1	01	01	H0351_044_3	4	Specialty Tier	4	010010	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												32	32	32					32	32	32										32	32	32				32	32	32			32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0351	044	3	1	01	01	H0351_044_3	4	Select Care Drugs	4	010010	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0354	001	0	1	01	01	H0354_001_0	5	Preferred Generic	4	001000	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		31								10.00	20.00	30.00					5.00	10.00	15.00					10.00		30.00																10.00				10.00			0.33	0.17	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0354	001	0	1	01	01	H0354_001_0	5	Generic	4	010000	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		31								20.00	40.00	60.00					15.00	30.00	45.00					20.00		60.00																20.00				20.00			0.67	0.50	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0354	001	0	1	01	01	H0354_001_0	5	Preferred Brand	4	000101	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					47.00		141.00																47.00				47.00			1.57	1.40	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0354	001	0	1	01	01	H0354_001_0	5	Non-Preferred Drug	4	100100	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00		300.00																100.00				100.00			3.33	3.17	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0354	001	0	1	01	01	H0354_001_0	5	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		31											582.46	33						407.33	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0354	024	0	1	01	01	H0354_024_0	5	Preferred Generic	4	001000	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		31								10.00	20.00	30.00					5.00	10.00	15.00					10.00		30.00																10.00				10.00			0.33	0.17	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0354	024	0	1	01	01	H0354_024_0	5	Generic	4	010000	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		31								20.00	40.00	60.00					15.00	30.00	45.00					20.00		60.00																20.00				20.00			0.67	0.50	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0354	024	0	1	01	01	H0354_024_0	5	Preferred Brand	4	000101	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					47.00		141.00																47.00				47.00			1.57	1.40	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0354	024	0	1	01	01	H0354_024_0	5	Non-Preferred Drug	4	100100	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00		300.00																100.00				100.00			3.33	3.17	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0354	024	0	1	01	01	H0354_024_0	5	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		31											622.00	33						441.19	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0354	027	0	1	01	01	H0354_027_0	6	Preferred Generic	4	001000	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		31								10.00	20.00	30.00					5.00	10.00	15.00					10.00		30.00																10.00				10.00			0.33	0.17	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0354	027	0	1	01	01	H0354_027_0	6	Generic	4	010000	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		31								20.00	40.00	60.00					15.00	30.00	45.00					20.00		60.00																20.00				20.00			0.67	0.50	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0354	027	0	1	01	01	H0354_027_0	6	Preferred Brand	4	000101	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					47.00		141.00																47.00				47.00			1.57	1.40	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0354	027	0	1	01	01	H0354_027_0	6	Non-Preferred Drug	4	100100	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00		300.00																100.00				100.00			3.33	3.17	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0354	027	0	1	01	01	H0354_027_0	6	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		31											705.83	33						583.22	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	003	1	1	01	01	H0439_003_1	4	Preferred Generic	4	001000	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		31								8.00	16.00	24.00					3.00	6.00	9.00					8.00		24.00																8.00				8.00			0.27	0.10	0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	003	1	1	01	01	H0439_003_1	4	Generic	4	010000	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		31								17.00	34.00	51.00					12.00	24.00	36.00					17.00		51.00																17.00				17.00			0.57	0.40	0.57			0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	003	1	1	01	01	H0439_003_1	4	Preferred Brand	4	000101	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					47.00		141.00																47.00				47.00			1.57	1.40	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	003	1	1	01	01	H0439_003_1	4	Non-Preferred Drug	4	100100	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		31								90.00	180.00	270.00					85.00	170.00	255.00					90.00		270.00																90.00				90.00			3.00	2.83	3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	003	1	1	01	01	H0439_003_1	4	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		31											404.29	28						345.12	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	003	2	1	01	01	H0439_003_2	4	Preferred Generic	4	001000	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		31								8.00	16.00	24.00					3.00	6.00	9.00					8.00		24.00																8.00				8.00			0.27	0.10	0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	003	2	1	01	01	H0439_003_2	4	Generic	4	010000	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		31								17.00	34.00	51.00					12.00	24.00	36.00					17.00		51.00																17.00				17.00			0.57	0.40	0.57			0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	003	2	1	01	01	H0439_003_2	4	Preferred Brand	4	000101	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					47.00		141.00																47.00				47.00			1.57	1.40	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	003	2	1	01	01	H0439_003_2	4	Non-Preferred Drug	4	100100	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		31								90.00	180.00	270.00					85.00	170.00	255.00					90.00		270.00																90.00				90.00			3.00	2.83	3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0439	003	2	1	01	01	H0439_003_2	4	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		31											404.29	28						345.12	28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0480	001	0	1	48	05	H0480_001_0	4	Generic Drugs	4	010000			1	1	110		01	100		1	30		90				2	2			90				30		31																																														0.00						0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0480	001	0	1	48	05	H0480_001_0	4	Brand Drugs	4	000010			2	1	110		01	100		1	30		90				2	2			90				30		31																																														0.00						0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0480	001	0	1	48	05	H0480_001_0	4	Non-Medicare Rx/OTC Drugs	4	010010			3	1	110		01	100		1	30		90				1	1			90				30		31																																														0.00						0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0490	004	0	1	01	01	H0490_004_0	15	Preferred Generic	3	001001	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												
H0490	004	0	1	01	01	H0490_004_0	15	Generic	3	010001	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	18.00																6.00				6.00		0.19			0.19			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0490	004	0	1	01	01	H0490_004_0	15	Preferred Brand	3	000101	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	46.00	92.00	138.00																			46.00	92.00	138.00																46.00				46.00		1.48			1.48			1.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0490	004	0	1	01	01	H0490_004_0	15	Non-Preferred Drug	3	100100	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				78.32	31	31	31																		31	31	31															31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0490	004	0	1	01	01	H0490_004_0	15	Specialty Tier	3	010010	1	1	5	1	010		01	010		1	31								31						31		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0504	015	0	1	01	01	H0504_015_0	5	Preferred Generic	4	001010	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, Injectable Drugs, Specialty Tier												
H0504	015	0	1	01	01	H0504_015_0	5	Preferred Generic	4	001010	1	2	1	3		111	01	100		1				30	60	90	1	2			90				30		31								7.00	14.00	21.00					0.00	0.00	0.00							0.00																7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
H0504	015	0	1	01	01	H0504_015_0	5	Generic	4	010010	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	10.00							10.00																12.00				12.00			0.40	0.17				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	015	0	1	01	01	H0504_015_0	5	Generic	4	010010	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	10.00							10.00																12.00				12.00			0.40	0.17				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
H0504	015	0	1	01	01	H0504_015_0	5	Preferred Brand	4	010001	1	2	3	1		111	01	100		1				30	60	90	2	2			90				30		31								47.00	94.00	141.00					40.00	80.00	80.00							80.00																47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	015	0	1	01	01	H0504_015_0	5	Non-Preferred Brand	4	110000	1	2	4	1		111	01	100		1				30	60	90	2	2			90				30		31								95.00	190.00	285.00					88.00	176.00	176.00							176.00																95.00				95.00			3.17	2.93				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	015	0	1	01	01	H0504_015_0	5	Injectable Drugs	4	010010	1	1	5	1		111	01	100		1				30	60	90	2	2			90				30		31											76.40	33	33	33				76.40	33	33	33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	015	0	1	01	01	H0504_015_0	5	Specialty Tier	4	010010	1	1	6	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	017	0	1	01	01	H0504_017_0	4	Preferred Generic	4	001010	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, Injectable Drugs, Specialty Tier												
H0504	017	0	1	01	01	H0504_017_0	4	Preferred Generic	4	001010	1	2	1	3		111	01	100		1				30	60	90	1	2			90				30		31								7.00	14.00	21.00					0.00	0.00	0.00							0.00																7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
H0504	017	0	1	01	01	H0504_017_0	4	Generic	4	010010	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	10.00							10.00																12.00				12.00			0.40	0.17				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	017	0	1	01	01	H0504_017_0	4	Generic	4	010010	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	10.00							10.00																12.00				12.00			0.40	0.17				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
H0504	017	0	1	01	01	H0504_017_0	4	Preferred Brand	4	010001	1	2	3	1		111	01	100		1				30	60	90	2	2			90				30		31								47.00	94.00	141.00					40.00	80.00	80.00							80.00																47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	017	0	1	01	01	H0504_017_0	4	Non-Preferred Brand	4	110000	1	2	4	1		111	01	100		1				30	60	90	2	2			90				30		31								95.00	190.00	285.00					88.00	176.00	176.00							176.00																95.00				95.00			3.17	2.93				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	017	0	1	01	01	H0504_017_0	4	Injectable Drugs	4	010010	1	1	5	1		111	01	100		1				30	60	90	2	2			90				30		31											66.67	33	33	33				66.67	33	33	33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	017	0	1	01	01	H0504_017_0	4	Specialty Tier	4	010010	1	1	6	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	021	0	1	01	01	H0504_021_0	6	Preferred Generic	4	001010	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, Injectable Drugs, Specialty Tier												
H0504	021	0	1	01	01	H0504_021_0	6	Preferred Generic	4	001010	1	2	1	3		111	01	100		1				30	60	90	1	2			90				30		31								7.00	14.00	21.00					0.00	0.00	0.00							0.00																7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
H0504	021	0	1	01	01	H0504_021_0	6	Generic	4	010010	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	6.00							6.00																10.00				10.00			0.33	0.10				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	021	0	1	01	01	H0504_021_0	6	Generic	4	010010	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	6.00							6.00																10.00				10.00			0.33	0.10				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
H0504	021	0	1	01	01	H0504_021_0	6	Preferred Brand	4	010001	1	2	3	1		111	01	100		1				30	60	90	2	2			90				30		31								37.00	74.00	111.00					30.00	60.00	60.00							60.00																37.00				37.00			1.23	1.00				1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	021	0	1	01	01	H0504_021_0	6	Preferred Brand	4	010001	1	2	3	3		111	01	100		1				30	60	90	2	2			90				30		31								37.00	74.00	111.00					30.00	60.00	60.00							60.00																37.00				37.00			1.23	1.00				1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										2	2	
H0504	021	0	1	01	01	H0504_021_0	6	Non-Preferred Brand	4	110000	1	2	4	1		111	01	100		1				30	60	90	2	2			90				30		31								72.00	144.00	216.00					65.00	130.00	130.00							130.00																72.00				72.00			2.40	2.17				2.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	021	0	1	01	01	H0504_021_0	6	Injectable Drugs	4	010010	1	1	5	1		111	01	100		1				30	60	90	2	2			90				30		31											84.44	33	33	33				84.44	33	33	33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	021	0	1	01	01	H0504_021_0	6	Specialty Tier	4	010010	1	1	6	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	026	0	1	01	01	H0504_026_0	4	Preferred Generic	4	001010	1	2	1	1		111	01	100		1				30	60	90	1	2			90				30		31								8.00	16.00	24.00					3.00	6.00	6.00							6.00																8.00				8.00			0.27	0.10				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	026	0	1	01	01	H0504_026_0	4	Generic	4	010010	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	20.00							20.00																18.00				18.00			0.60	0.33				0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	026	0	1	01	01	H0504_026_0	4	Preferred Brand	4	010001	1	2	3	1		111	01	100		1				30	60	90	2	2			90				30		31								47.00	94.00	141.00					40.00	80.00	80.00							80.00																47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	026	0	1	01	01	H0504_026_0	4	Non-Preferred Brand	4	110000	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	190.00							190.00																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	026	0	1	01	01	H0504_026_0	4	Injectable Drugs	4	010010	1	1	5	1		111	01	100		1				30	60	90	2	2			90				30		31											86.75	33	33	33				86.75	33	33	33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	026	0	1	01	01	H0504_026_0	4	Specialty Tier	4	010010	1	1	6	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	028	0	1	01	01	H0504_028_0	4	Preferred Generic	4	001010	1	2	1	1		111	01	100		1				30	60	90	1	2			90				30		31								8.00	16.00	24.00					3.00	6.00	6.00							6.00																8.00				8.00			0.27	0.10				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	028	0	1	01	01	H0504_028_0	4	Preferred Generic	4	001010	1	2	1	3		111	01	100		1				30	60	90	1	2			90				30		31								8.00	16.00	24.00					3.00	6.00	6.00							6.00																8.00				8.00			0.27	0.10				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
H0504	028	0	1	01	01	H0504_028_0	4	Generic	4	010010	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	20.00							20.00																18.00				18.00			0.60	0.33				0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	028	0	1	01	01	H0504_028_0	4	Preferred Brand	4	010001	1	2	3	1		111	01	100		1				30	60	90	2	2			90				30		31								47.00	94.00	141.00					40.00	80.00	80.00							80.00																47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	028	0	1	01	01	H0504_028_0	4	Non-Preferred Brand	4	110000	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	190.00							190.00																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	028	0	1	01	01	H0504_028_0	4	Injectable Drugs	4	010010	1	1	5	1		111	01	100		1				30	60	90	2	2			90				30		31											77.52	33	33	33				77.52	33	33	33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	028	0	1	01	01	H0504_028_0	4	Specialty Tier	4	010010	1	1	6	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	029	0	1	01	01	H0504_029_0	4	Preferred Generic	4	001010	1	2	1	1		111	01	100		1				30	60	90	1	2			90				30		31								10.00	20.00	30.00					5.00	10.00	10.00							10.00																10.00				10.00			0.33	0.17				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	029	0	1	01	01	H0504_029_0	4	Generic	4	010010	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	20.00							20.00																18.00				18.00			0.60	0.33				0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	029	0	1	01	01	H0504_029_0	4	Preferred Brand	4	010001	1	2	3	1		111	01	100		1				30	60	90	2	2			90				30		31								47.00	94.00	141.00					40.00	80.00	80.00							80.00																47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	029	0	1	01	01	H0504_029_0	4	Non-Preferred Brand	4	110000	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	190.00							190.00																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	029	0	1	01	01	H0504_029_0	4	Injectable Drugs	4	010010	1	1	5	1		111	01	100		1				30	60	90	2	2			90				30		31											99.52	33	33	33				99.52	33	33	33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	029	0	1	01	01	H0504_029_0	4	Specialty Tier	4	010010	1	1	6	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	031	0	1	01	01	H0504_031_0	4	Preferred Generic	4	001010	1	2	1	1		111	01	100		1				30	60	90	1	2			90				30		31								8.00	16.00	24.00					3.00	6.00	6.00							6.00																8.00				8.00			0.27	0.10				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	031	0	1	01	01	H0504_031_0	4	Generic	4	010010	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	20.00							20.00																18.00				18.00			0.60	0.33				0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	031	0	1	01	01	H0504_031_0	4	Preferred Brand	4	010001	1	2	3	1		111	01	100		1				30	60	90	2	2			90				30		31								47.00	94.00	141.00					40.00	80.00	80.00							80.00																47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	031	0	1	01	01	H0504_031_0	4	Non-Preferred Brand	4	110000	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	190.00							190.00																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	031	0	1	01	01	H0504_031_0	4	Injectable Drugs	4	010010	1	1	5	1		111	01	100		1				30	60	90	2	2			90				30		31											94.17	33	33	33				94.17	33	33	33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	031	0	1	01	01	H0504_031_0	4	Specialty Tier	4	010010	1	1	6	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	037	0	1	01	01	H0504_037_0	4	Preferred Generic	4	001010	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, Injectable Drugs, Specialty Tier												
H0504	037	0	1	01	01	H0504_037_0	4	Generic	4	010010	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	10.00							10.00																12.00				12.00			0.40	0.17				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	037	0	1	01	01	H0504_037_0	4	Preferred Brand	4	010001	1	2	3	1		111	01	100		1				30	60	90	2	2			90				30		31								47.00	94.00	141.00					40.00	80.00	80.00							80.00																47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	037	0	1	01	01	H0504_037_0	4	Non-Preferred Brand	4	110000	1	2	4	1		111	01	100		1				30	60	90	2	2			90				30		31								95.00	190.00	285.00					88.00	176.00	176.00							176.00																95.00				95.00			3.17	2.93				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	037	0	1	01	01	H0504_037_0	4	Injectable Drugs	4	010010	1	1	5	1		111	01	100		1				30	60	90	2	2			90				30		31											81.91	33	33	33				81.91	33	33	33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0504	037	0	1	01	01	H0504_037_0	4	Specialty Tier	4	010010	1	1	6	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H0523	002	0	1	01	01	H0523_002_0	4	Preferred Generic	4	001010	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0523	002	0	1	01	01	H0523_002_0	4	Preferred Generic	4	001010	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0523	002	0	1	01	01	H0523_002_0	4	Generic	4	010010	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0523	002	0	1	01	01	H0523_002_0	4	Generic	4	010010	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0523	002	0	1	01	01	H0523_002_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0523	002	0	1	01	01	H0523_002_0	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0523	002	0	1	01	01	H0523_002_0	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0523	022	0	1	01	01	H0523_022_0	4	Preferred Generic	4	001010	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0523	022	0	1	01	01	H0523_022_0	4	Preferred Generic	4	001010	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0523	022	0	1	01	01	H0523_022_0	4	Generic	4	010010	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0523	022	0	1	01	01	H0523_022_0	4	Generic	4	010010	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0523	022	0	1	01	01	H0523_022_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0523	031	0	1	01	01	H0523_031_0	5	Preferred Generic	4	001010	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0523	031	0	1	01	01	H0523_031_0	5	Preferred Generic	4	001010	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0523	031	0	1	01	01	H0523_031_0	5	Generic	4	010010	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0523	031	0	1	01	01	H0523_031_0	5	Generic	4	010010	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0523	031	0	1	01	01	H0523_031_0	5	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0523	052	0	1	01	01	H0523_052_0	4	Preferred Generic	4	001010	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0523	052	0	1	01	01	H0523_052_0	4	Preferred Generic	4	001010	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0523	052	0	1	01	01	H0523_052_0	4	Generic	4	010010	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0523	052	0	1	01	01	H0523_052_0	4	Generic	4	010010	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0523	052	0	1	01	01	H0523_052_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0523	060	0	1	01	01	H0523_060_0	4	Preferred Generic	4	001010	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0523	060	0	1	01	01	H0523_060_0	4	Preferred Generic	4	001010	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0523	060	0	1	01	01	H0523_060_0	4	Generic	4	010010	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0523	060	0	1	01	01	H0523_060_0	4	Generic	4	010010	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0523	060	0	1	01	01	H0523_060_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	060	0	1	01	01	H0523_060_0	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	060	0	1	01	01	H0523_060_0	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0523	061	0	1	01	01	H0523_061_0	5	Preferred Generic	4	001010	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0523	061	0	1	01	01	H0523_061_0	5	Preferred Generic	4	001010	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0523	061	0	1	01	01	H0523_061_0	5	Generic	4	010010	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0523	061	0	1	01	01	H0523_061_0	5	Generic	4	010010	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0523	061	0	1	01	01	H0523_061_0	5	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0523	063	0	1	01	01	H0523_063_0	4	Preferred Generic	4	001010	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0523	063	0	1	01	01	H0523_063_0	4	Preferred Generic	4	001010	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0523	063	0	1	01	01	H0523_063_0	4	Generic	4	010010	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0523	063	0	1	01	01	H0523_063_0	4	Generic	4	010010	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0523	063	0	1	01	01	H0523_063_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0523	063	0	1	01	01	H0523_063_0	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0523	063	0	1	01	01	H0523_063_0	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0524	002	0	2	01	01	H0524_002_0	7	Preferred Generic	4	001000	1	2	1	1	110		01	110		1	30		100				2	2	30		100				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	002	0	2	01	01	H0524_002_0	7	Preferred Generic	4	001000	1	2	1	3	110		01	110		1	30		100				2	2	30		100				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	002	0	2	01	01	H0524_002_0	7	Generic	4	010000	1	2	2	1	110		01	110		1	30		100				2	2	30		100				30		31	12.00		36.00																			12.00		24.00																12.00				12.00		0.40			0.40			0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	002	0	2	01	01	H0524_002_0	7	Generic	4	010000	1	2	2	3	110		01	110		1	30		100				2	2	30		100				30		31	12.00		36.00																			12.00		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	002	0	2	01	01	H0524_002_0	7	Preferred Brand	4	000001	1	2	3	1	110		01	110		1	30		100				2	2	30		100				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 Brand, Specialty Tier, Vaccines												
H0524	002	0	2	01	01	H0524_002_0	7	Non-Preferred Brand	4	100000	1	2	4	1	110		01	110		1	30		100				2	2	30		100				30		31	95.00		285.00																			95.00		190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	002	0	2	01	01	H0524_002_0	7	Specialty Tier	4	010010	1	1	5	1	110		01	110		1	30		100				2	2	30		100				30		31				2115.00	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	002	0	2	01	01	H0524_002_0	7	Vaccines	4	000001	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	002	0	2	01	01	H0524_002_0	7	Vaccines	4	000001	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	003	0	1	01	01	H0524_003_0	7	Preferred Generic	4	001000	1	2	1	1	110		01	110		1	30		100				2	2	30		100				30		31	3.00		9.00																			3.00		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	7	Preferred Generic	4	001000	1	2	1	3	110		01	110		1	30		100				2	2	30		100				30		31	3.00		9.00																			3.00		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	7	Generic	4	010000	1	2	2	1	110		01	110		1	30		100				2	2	30		100				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 Brand, Specialty Tier, Vaccines												
H0524	003	0	1	01	01	H0524_003_0	7	Generic	4	010000	1	2	2	3	110		01	110		1	30		100				2	2	30		100				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 Brand, Specialty Tier, Vaccines										1		
H0524	003	0	1	01	01	H0524_003_0	7	Preferred Brand	4	000001	1	2	3	1	110		01	110		1	30		100				2	2	30		100				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 Brand, Specialty Tier, Vaccines												
H0524	003	0	1	01	01	H0524_003_0	7	Non-Preferred Brand	4	100000	1	2	4	1	110		01	110		1	30		100				2	2	30		100				30		31	95.00		285.00																			95.00		190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	003	0	1	01	01	H0524_003_0	7	Specialty Tier	4	010010	1	1	5	1	110		01	110		1	30		100				2	2	30		100				30		31				1974.00	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	003	0	1	01	01	H0524_003_0	7	Vaccines	4	000001	1	2	6	1	010		01			1	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	7	Vaccines	4	000001	1	2	6	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	7	Preferred Generic	4	001000	1	2	1	1	110		01	110		1	30		100				2	2	30		100				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	008	0	1	01	01	H0524_008_0	7	Preferred Generic	4	001000	1	2	1	3	110		01	110		1	30		100				2	2	30		100				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	008	0	1	01	01	H0524_008_0	7	Generic	4	010000	1	2	2	1	110		01	110		1	30		100				2	2	30		100				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 Brand, Specialty Tier, Vaccines												
H0524	008	0	1	01	01	H0524_008_0	7	Generic	4	010000	1	2	2	3	110		01	110		1	30		100				2	2	30		100				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 Brand, Specialty Tier, Vaccines										1		
H0524	008	0	1	01	01	H0524_008_0	7	Preferred Brand	4	000001	1	2	3	1	110		01	110		1	30		100				2	2	30		100				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 Brand, Specialty Tier, Vaccines												
H0524	008	0	1	01	01	H0524_008_0	7	Non-Preferred Brand	4	100000	1	2	4	1	110		01	110		1	30		100				2	2	30		100				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 Brand, Specialty Tier, Vaccines												
H0524	008	0	1	01	01	H0524_008_0	7	Specialty Tier	4	010010	1	1	5	1	110		01	110		1	30		100				2	2	30		100				30		31				1942.00	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	7	Vaccines	4	000001	1	2	6	1	010		01			1	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	7	Vaccines	4	000001	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	010	0	2	01	01	H0524_010_0	7	Preferred Generic	4	001000	1	2	1	1	110		01	110		1	30		100				2	2	30		100				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	010	0	2	01	01	H0524_010_0	7	Preferred Generic	4	001000	1	2	1	3	110		01	110		1	30		100				2	2	30		100				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	010	0	2	01	01	H0524_010_0	7	Generic	4	010000	1	2	2	1	110		01	110		1	30		100				2	2	30		100				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 Brand, Specialty Tier, Vaccines												
H0524	010	0	2	01	01	H0524_010_0	7	Generic	4	010000	1	2	2	3	110		01	110		1	30		100				2	2	30		100				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 Brand, Specialty Tier, Vaccines										1		
H0524	010	0	2	01	01	H0524_010_0	7	Preferred Brand	4	000001	1	2	3	1	110		01	110		1	30		100				2	2	30		100				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 Brand, Specialty Tier, Vaccines												
H0524	010	0	2	01	01	H0524_010_0	7	Non-Preferred Brand	4	100000	1	2	4	1	110		01	110		1	30		100				2	2	30		100				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 Brand, Specialty Tier, Vaccines												
H0524	010	0	2	01	01	H0524_010_0	7	Specialty Tier	4	010010	1	1	5	1	110		01	110		1	30		100				2	2	30		100				30		31				2159.00	33		33																		33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	010	0	2	01	01	H0524_010_0	7	Vaccines	4	000001	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	010	0	2	01	01	H0524_010_0	7	Vaccines	4	000001	1	2	6	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	8	Preferred Generic	4	001000	1	2	1	1	110		01	110		1	30		100				2	2	30		100				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	013	0	1	01	01	H0524_013_0	8	Preferred Generic	4	001000	1	2	1	3	110		01	110		1	30		100				2	2	30		100				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	013	0	1	01	01	H0524_013_0	8	Generic	4	010000	1	2	2	1	110		01	110		1	30		100				2	2	30		100				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 Brand, Specialty Tier, Vaccines												
H0524	013	0	1	01	01	H0524_013_0	8	Generic	4	010000	1	2	2	3	110		01	110		1	30		100				2	2	30		100				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 Brand, Specialty Tier, Vaccines										1		
H0524	013	0	1	01	01	H0524_013_0	8	Preferred Brand	4	000001	1	2	3	1	110		01	110		1	30		100				2	2	30		100				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 Brand, Specialty Tier, Vaccines												
H0524	013	0	1	01	01	H0524_013_0	8	Non-Preferred Brand	4	100000	1	2	4	1	110		01	110		1	30		100				2	2	30		100				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 Brand, Specialty Tier, Vaccines												
H0524	013	0	1	01	01	H0524_013_0	8	Specialty Tier	4	010010	1	1	5	1	110		01	110		1	30		100				2	2	30		100				30		31				1912.00	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	8	Vaccines	4	000001	1	2	6	1	010		01			1	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	8	Vaccines	4	000001	1	2	6	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	001000	1	2	1	1	110		01	110		1	30		100				2	2	30		100				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	015	0	1	01	01	H0524_015_0	9	Preferred Generic	4	001000	1	2	1	3	110		01	110		1	30		100				2	2	30		100				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	015	0	1	01	01	H0524_015_0	9	Generic	4	010000	1	2	2	1	110		01	110		1	30		100				2	2	30		100				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 Brand, Specialty Tier, Vaccines												
H0524	015	0	1	01	01	H0524_015_0	9	Generic	4	010000	1	2	2	3	110		01	110		1	30		100				2	2	30		100				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 Brand, Specialty Tier, Vaccines										1		
H0524	015	0	1	01	01	H0524_015_0	9	Preferred Brand	4	000001	1	2	3	1	110		01	110		1	30		100				2	2	30		100				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 Brand, Specialty Tier, Vaccines												
H0524	015	0	1	01	01	H0524_015_0	9	Non-Preferred Brand	4	100000	1	2	4	1	110		01	110		1	30		100				2	2	30		100				30		31	95.00		285.00																			95.00		190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	015	0	1	01	01	H0524_015_0	9	Specialty Tier	4	010010	1	1	5	1	110		01	110		1	30		100				2	2	30		100				30		31				1857.00	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	015	0	1	01	01	H0524_015_0	9	Vaccines	4	000001	1	2	6	1	010		01			1	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	000001	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	029	0	1	01	01	H0524_029_0	8	Preferred Generic	3	001000	1	2	1	1	110		01	110		1	30		100				2	2	30		100				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 Brand, Specialty Tier, Vaccines												
H0524	029	0	1	01	01	H0524_029_0	8	Generic	3	010000	1	2	2	1	110		01	110		1	30		100				2	2	30		100				30		31	20.00		60.00																			20.00		40.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	029	0	1	01	01	H0524_029_0	8	Preferred Brand	3	000001	1	2	3	1	110		01	110		1	30		100				2	2	30		100				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 Brand, Specialty Tier, Vaccines												
H0524	029	0	1	01	01	H0524_029_0	8	Non-Preferred Brand	3	100000	1	2	4	1	110		01	110		1	30		100				2	2	30		100				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 Brand, Specialty Tier, Vaccines												
H0524	029	0	1	01	01	H0524_029_0	8	Specialty Tier	3	010010	1	1	5	1	110		01	110		1	30		100				2	2	30		100				30		31				1569.00	33		33																		33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	029	0	1	01	01	H0524_029_0	8	Vaccines	3	000001	1	2	6	1	010		01			1	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	7	Preferred Generic	4	001000	1	2	1	1	110		01	110		1	30		100				2	2	30		100				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	031	0	1	01	01	H0524_031_0	7	Preferred Generic	4	001000	1	2	1	3	110		01	110		1	30		100				2	2	30		100				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	031	0	1	01	01	H0524_031_0	7	Generic	4	010000	1	2	2	1	110		01	110		1	30		100				2	2	30		100				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 Brand, Specialty Tier, Vaccines												
H0524	031	0	1	01	01	H0524_031_0	7	Generic	4	010000	1	2	2	3	110		01	110		1	30		100				2	2	30		100				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 Brand, Specialty Tier, Vaccines										1		
H0524	031	0	1	01	01	H0524_031_0	7	Preferred Brand	4	000001	1	2	3	1	110		01	110		1	30		100				2	2	30		100				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 Brand, Specialty Tier, Vaccines												
H0524	031	0	1	01	01	H0524_031_0	7	Non-Preferred Brand	4	100000	1	2	4	1	110		01	110		1	30		100				2	2	30		100				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 Brand, Specialty Tier, Vaccines												
H0524	031	0	1	01	01	H0524_031_0	7	Specialty Tier	4	010010	1	1	5	1	110		01	110		1	30		100				2	2	30		100				30		31				2142.00	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	7	Vaccines	4	000001	1	2	6	1	010		01			1	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	7	Vaccines	4	000001	1	2	6	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	7	Preferred Generic	4	001000	1	2	1	1	110		01	110		1	30		100				2	2	30		100				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	032	0	1	01	01	H0524_032_0	7	Preferred Generic	4	001000	1	2	1	3	110		01	110		1	30		100				2	2	30		100				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	032	0	1	01	01	H0524_032_0	7	Generic	4	010000	1	2	2	1	110		01	110		1	30		100				2	2	30		100				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 Brand, Specialty Tier, Vaccines												
H0524	032	0	1	01	01	H0524_032_0	7	Generic	4	010000	1	2	2	3	110		01	110		1	30		100				2	2	30		100				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 Brand, Specialty Tier, Vaccines										1		
H0524	032	0	1	01	01	H0524_032_0	7	Preferred Brand	4	000001	1	2	3	1	110		01	110		1	30		100				2	2	30		100				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 Brand, Specialty Tier, Vaccines												
H0524	032	0	1	01	01	H0524_032_0	7	Non-Preferred Brand	4	100000	1	2	4	1	110		01	110		1	30		100				2	2	30		100				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 Brand, Specialty Tier, Vaccines												
H0524	032	0	1	01	01	H0524_032_0	7	Specialty Tier	4	010010	1	1	5	1	110		01	110		1	30		100				2	2	30		100				30		31				2132.00	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	7	Vaccines	4	000001	1	2	6	1	010		01			1	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	7	Vaccines	4	000001	1	2	6	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	7	Preferred Generic	4	001000	1	2	1	1	110		01	110		1	30		100				2	2	30		100				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	033	0	1	01	01	H0524_033_0	7	Preferred Generic	4	001000	1	2	1	3	110		01	110		1	30		100				2	2	30		100				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	033	0	1	01	01	H0524_033_0	7	Generic	4	010000	1	2	2	1	110		01	110		1	30		100				2	2	30		100				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 Brand, Specialty Tier, Vaccines												
H0524	033	0	1	01	01	H0524_033_0	7	Generic	4	010000	1	2	2	3	110		01	110		1	30		100				2	2	30		100				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 Brand, Specialty Tier, Vaccines										1		
H0524	033	0	1	01	01	H0524_033_0	7	Preferred Brand	4	000001	1	2	3	1	110		01	110		1	30		100				2	2	30		100				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 Brand, Specialty Tier, Vaccines												
H0524	033	0	1	01	01	H0524_033_0	7	Non-Preferred Brand	4	100000	1	2	4	1	110		01	110		1	30		100				2	2	30		100				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 Brand, Specialty Tier, Vaccines												
H0524	033	0	1	01	01	H0524_033_0	7	Specialty Tier	4	010010	1	1	5	1	110		01	110		1	30		100				2	2	30		100				30		31				2085.00	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	7	Vaccines	4	000001	1	2	6	1	010		01			1	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	7	Vaccines	4	000001	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	034	0	1	01	01	H0524_034_0	6	Preferred Generic	4	001000	1	2	1	1	110		01	110		1	30		100				2	2	30		100				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	034	0	1	01	01	H0524_034_0	6	Preferred Generic	4	001000	1	2	1	3	110		01	110		1	30		100				2	2	30		100				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	034	0	1	01	01	H0524_034_0	6	Generic	4	010000	1	2	2	1	110		01	110		1	30		100				2	2	30		100				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 Brand, Specialty Tier, Vaccines												
H0524	034	0	1	01	01	H0524_034_0	6	Generic	4	010000	1	2	2	3	110		01	110		1	30		100				2	2	30		100				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 Brand, Specialty Tier, Vaccines										1		
H0524	034	0	1	01	01	H0524_034_0	6	Preferred Brand	4	000001	1	2	3	1	110		01	110		1	30		100				2	2	30		100				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 Brand, Specialty Tier, Vaccines												
H0524	034	0	1	01	01	H0524_034_0	6	Non-Preferred Brand	4	100000	1	2	4	1	110		01	110		1	30		100				2	2	30		100				30		31	95.00		285.00																			95.00		190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	034	0	1	01	01	H0524_034_0	6	Specialty Tier	4	010010	1	1	5	1	110		01	110		1	30		100				2	2	30		100				30		31				1925.00	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	034	0	1	01	01	H0524_034_0	6	Vaccines	4	000001	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	034	0	1	01	01	H0524_034_0	6	Vaccines	4	000001	1	2	6	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	7	Preferred Generic	4	001000	1	2	1	1	110		01	110		1	30		100				2	2	30		100				30		31	3.00		9.00																			3.00		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	7	Preferred Generic	4	001000	1	2	1	3	110		01	110		1	30		100				2	2	30		100				30		31	3.00		9.00																			3.00		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	7	Generic	4	010000	1	2	2	1	110		01	110		1	30		100				2	2	30		100				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 Brand, Specialty Tier, Vaccines												
H0524	035	0	1	01	01	H0524_035_0	7	Generic	4	010000	1	2	2	3	110		01	110		1	30		100				2	2	30		100				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 Brand, Specialty Tier, Vaccines										1		
H0524	035	0	1	01	01	H0524_035_0	7	Preferred Brand	4	000001	1	2	3	1	110		01	110		1	30		100				2	2	30		100				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 Brand, Specialty Tier, Vaccines												
H0524	035	0	1	01	01	H0524_035_0	7	Non-Preferred Brand	4	100000	1	2	4	1	110		01	110		1	30		100				2	2	30		100				30		31	95.00		285.00																			95.00		190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	035	0	1	01	01	H0524_035_0	7	Specialty Tier	4	010010	1	1	5	1	110		01	110		1	30		100				2	2	30		100				30		31				1608.00	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	035	0	1	01	01	H0524_035_0	7	Vaccines	4	000001	1	2	6	1	010		01			1	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	7	Vaccines	4	000001	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	036	0	1	01	01	H0524_036_0	7	Preferred Generic	4	001000	1	2	1	1	110		01	110		1	30		100				2	2	30		100				30		31	3.00		9.00																			3.00		6.00																3.00				3.00		0.10			0.10			0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	036	0	1	01	01	H0524_036_0	7	Preferred Generic	4	001000	1	2	1	3	110		01	110		1	30		100				2	2	30		100				30		31	3.00		9.00																			3.00		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	036	0	1	01	01	H0524_036_0	7	Generic	4	010000	1	2	2	1	110		01	110		1	30		100				2	2	30		100				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 Brand, Specialty Tier, Vaccines												
H0524	036	0	1	01	01	H0524_036_0	7	Generic	4	010000	1	2	2	3	110		01	110		1	30		100				2	2	30		100				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 Brand, Specialty Tier, Vaccines										1		
H0524	036	0	1	01	01	H0524_036_0	7	Preferred Brand	4	000001	1	2	3	1	110		01	110		1	30		100				2	2	30		100				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 Brand, Specialty Tier, Vaccines												
H0524	036	0	1	01	01	H0524_036_0	7	Non-Preferred Brand	4	100000	1	2	4	1	110		01	110		1	30		100				2	2	30		100				30		31	95.00		285.00																			95.00		190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	036	0	1	01	01	H0524_036_0	7	Specialty Tier	4	010010	1	1	5	1	110		01	110		1	30		100				2	2	30		100				30		31				2475.00	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	036	0	1	01	01	H0524_036_0	7	Vaccines	4	000001	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	036	0	1	01	01	H0524_036_0	7	Vaccines	4	000001	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	037	0	1	01	01	H0524_037_0	6	Preferred Generic	4	001000	1	2	1	1	110		01	110		1	30		100				2	2	30		100				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	037	0	1	01	01	H0524_037_0	6	Preferred Generic	4	001000	1	2	1	3	110		01	110		1	30		100				2	2	30		100				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	037	0	1	01	01	H0524_037_0	6	Generic	4	010000	1	2	2	1	110		01	110		1	30		100				2	2	30		100				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 Brand, Specialty Tier, Vaccines												
H0524	037	0	1	01	01	H0524_037_0	6	Generic	4	010000	1	2	2	3	110		01	110		1	30		100				2	2	30		100				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 Brand, Specialty Tier, Vaccines										1		
H0524	037	0	1	01	01	H0524_037_0	6	Preferred Brand	4	000001	1	2	3	1	110		01	110		1	30		100				2	2	30		100				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 Brand, Specialty Tier, Vaccines												
H0524	037	0	1	01	01	H0524_037_0	6	Non-Preferred Brand	4	100000	1	2	4	1	110		01	110		1	30		100				2	2	30		100				30		31	95.00		285.00																			95.00		190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	037	0	1	01	01	H0524_037_0	6	Specialty Tier	4	010010	1	1	5	1	110		01	110		1	30		100				2	2	30		100				30		31				2249.00	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	037	0	1	01	01	H0524_037_0	6	Vaccines	4	000001	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	037	0	1	01	01	H0524_037_0	6	Vaccines	4	000001	1	2	6	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	7	Preferred Generic	4	001000	1	2	1	1	110		01	110		1	30		100				2	2	30		100				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	038	0	1	01	01	H0524_038_0	7	Preferred Generic	4	001000	1	2	1	3	110		01	110		1	30		100				2	2	30		100				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	038	0	1	01	01	H0524_038_0	7	Generic	4	010000	1	2	2	1	110		01	110		1	30		100				2	2	30		100				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 Brand, Specialty Tier, Vaccines												
H0524	038	0	1	01	01	H0524_038_0	7	Generic	4	010000	1	2	2	3	110		01	110		1	30		100				2	2	30		100				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 Brand, Specialty Tier, Vaccines										1		
H0524	038	0	1	01	01	H0524_038_0	7	Preferred Brand	4	000001	1	2	3	1	110		01	110		1	30		100				2	2	30		100				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 Brand, Specialty Tier, Vaccines												
H0524	038	0	1	01	01	H0524_038_0	7	Non-Preferred Brand	4	100000	1	2	4	1	110		01	110		1	30		100				2	2	30		100				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 Brand, Specialty Tier, Vaccines												
H0524	038	0	1	01	01	H0524_038_0	7	Specialty Tier	4	010010	1	1	5	1	110		01	110		1	30		100				2	2	30		100				30		31				1859.00	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	7	Vaccines	4	000001	1	2	6	1	010		01			1	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	7	Vaccines	4	000001	1	2	6	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	7	Preferred Generic	4	001000	1	2	1	1	110		01	110		1	30		100				2	2	30		100				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	039	0	1	01	01	H0524_039_0	7	Preferred Generic	4	001000	1	2	1	3	110		01	110		1	30		100				2	2	30		100				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	039	0	1	01	01	H0524_039_0	7	Generic	4	010000	1	2	2	1	110		01	110		1	30		100				2	2	30		100				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 Brand, Specialty Tier, Vaccines												
H0524	039	0	1	01	01	H0524_039_0	7	Generic	4	010000	1	2	2	3	110		01	110		1	30		100				2	2	30		100				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 Brand, Specialty Tier, Vaccines										1		
H0524	039	0	1	01	01	H0524_039_0	7	Preferred Brand	4	000001	1	2	3	1	110		01	110		1	30		100				2	2	30		100				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 Brand, Specialty Tier, Vaccines												
H0524	039	0	1	01	01	H0524_039_0	7	Non-Preferred Brand	4	100000	1	2	4	1	110		01	110		1	30		100				2	2	30		100				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 Brand, Specialty Tier, Vaccines												
H0524	039	0	1	01	01	H0524_039_0	7	Specialty Tier	4	010010	1	1	5	1	110		01	110		1	30		100				2	2	30		100				30		31				2187.00	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	7	Vaccines	4	000001	1	2	6	1	010		01			1	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	7	Vaccines	4	000001	1	2	6	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	6	Preferred Generic	4	001000	1	2	1	1	110		01	110		1	30		100				2	2	30		100				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	040	0	1	01	01	H0524_040_0	6	Preferred Generic	4	001000	1	2	1	3	110		01	110		1	30		100				2	2	30		100				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	040	0	1	01	01	H0524_040_0	6	Generic	4	010000	1	2	2	1	110		01	110		1	30		100				2	2	30		100				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 Brand, Specialty Tier, Vaccines												
H0524	040	0	1	01	01	H0524_040_0	6	Generic	4	010000	1	2	2	3	110		01	110		1	30		100				2	2	30		100				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 Brand, Specialty Tier, Vaccines										1		
H0524	040	0	1	01	01	H0524_040_0	6	Preferred Brand	4	000001	1	2	3	1	110		01	110		1	30		100				2	2	30		100				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 Brand, Specialty Tier, Vaccines												
H0524	040	0	1	01	01	H0524_040_0	6	Non-Preferred Brand	4	100000	1	2	4	1	110		01	110		1	30		100				2	2	30		100				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 Brand, Specialty Tier, Vaccines												
H0524	040	0	1	01	01	H0524_040_0	6	Specialty Tier	4	010010	1	1	5	1	110		01	110		1	30		100				2	2	30		100				30		31				1899.00	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	6	Vaccines	4	000001	1	2	6	1	010		01			1	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	6	Vaccines	4	000001	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	041	0	1	01	01	H0524_041_0	7	Preferred Generic	4	001000	1	2	1	1	110		01	110		1	30		100				2	2	30		100				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	041	0	1	01	01	H0524_041_0	7	Preferred Generic	4	001000	1	2	1	3	110		01	110		1	30		100				2	2	30		100				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	041	0	1	01	01	H0524_041_0	7	Generic	4	010000	1	2	2	1	110		01	110		1	30		100				2	2	30		100				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 Brand, Specialty Tier, Vaccines												
H0524	041	0	1	01	01	H0524_041_0	7	Generic	4	010000	1	2	2	3	110		01	110		1	30		100				2	2	30		100				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 Brand, Specialty Tier, Vaccines										1		
H0524	041	0	1	01	01	H0524_041_0	7	Preferred Brand	4	000001	1	2	3	1	110		01	110		1	30		100				2	2	30		100				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 Brand, Specialty Tier, Vaccines												
H0524	041	0	1	01	01	H0524_041_0	7	Non-Preferred Brand	4	100000	1	2	4	1	110		01	110		1	30		100				2	2	30		100				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 Brand, Specialty Tier, Vaccines												
H0524	041	0	1	01	01	H0524_041_0	7	Specialty Tier	4	010010	1	1	5	1	110		01	110		1	30		100				2	2	30		100				30		31				1300.00	33		33																		33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	041	0	1	01	01	H0524_041_0	7	Vaccines	4	000001	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	041	0	1	01	01	H0524_041_0	7	Vaccines	4	000001	1	2	6	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	7	Preferred Generic	4	001000	1	2	1	1	110		01	110		1	30		100				2	2	30		100				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	042	0	1	01	01	H0524_042_0	7	Preferred Generic	4	001000	1	2	1	3	110		01	110		1	30		100				2	2	30		100				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	042	0	1	01	01	H0524_042_0	7	Generic	4	010000	1	2	2	1	110		01	110		1	30		100				2	2	30		100				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 Brand, Specialty Tier, Vaccines												
H0524	042	0	1	01	01	H0524_042_0	7	Generic	4	010000	1	2	2	3	110		01	110		1	30		100				2	2	30		100				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 Brand, Specialty Tier, Vaccines										1		
H0524	042	0	1	01	01	H0524_042_0	7	Preferred Brand	4	000001	1	2	3	1	110		01	110		1	30		100				2	2	30		100				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 Brand, Specialty Tier, Vaccines												
H0524	042	0	1	01	01	H0524_042_0	7	Non-Preferred Brand	4	100000	1	2	4	1	110		01	110		1	30		100				2	2	30		100				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 Brand, Specialty Tier, Vaccines												
H0524	042	0	1	01	01	H0524_042_0	7	Specialty Tier	4	010010	1	1	5	1	110		01	110		1	30		100				2	2	30		100				30		31				1888.00	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	7	Vaccines	4	000001	1	2	6	1	010		01			1	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	7	Vaccines	4	000001	1	2	6	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	7	Preferred Generic	4	001000	1	2	1	1	110		01	110		1	30		100				2	2	30		100				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	043	0	1	01	01	H0524_043_0	7	Preferred Generic	4	001000	1	2	1	3	110		01	110		1	30		100				2	2	30		100				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	043	0	1	01	01	H0524_043_0	7	Generic	4	010000	1	2	2	1	110		01	110		1	30		100				2	2	30		100				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 Brand, Specialty Tier, Vaccines												
H0524	043	0	1	01	01	H0524_043_0	7	Generic	4	010000	1	2	2	3	110		01	110		1	30		100				2	2	30		100				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 Brand, Specialty Tier, Vaccines										1		
H0524	043	0	1	01	01	H0524_043_0	7	Preferred Brand	4	000001	1	2	3	1	110		01	110		1	30		100				2	2	30		100				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 Brand, Specialty Tier, Vaccines												
H0524	043	0	1	01	01	H0524_043_0	7	Non-Preferred Brand	4	100000	1	2	4	1	110		01	110		1	30		100				2	2	30		100				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 Brand, Specialty Tier, Vaccines												
H0524	043	0	1	01	01	H0524_043_0	7	Specialty Tier	4	010010	1	1	5	1	110		01	110		1	30		100				2	2	30		100				30		31				1947.00	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	7	Vaccines	4	000001	1	2	6	1	010		01			1	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	7	Vaccines	4	000001	1	2	6	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	7	Preferred Generic	4	001000	1	2	1	1	110		01	110		1	30		100				2	2	30		100				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	046	0	1	01	01	H0524_046_0	7	Preferred Generic	4	001000	1	2	1	3	110		01	110		1	30		100				2	2	30		100				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	046	0	1	01	01	H0524_046_0	7	Generic	4	010000	1	2	2	1	110		01	110		1	30		100				2	2	30		100				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 Brand, Specialty Tier, Vaccines												
H0524	046	0	1	01	01	H0524_046_0	7	Generic	4	010000	1	2	2	3	110		01	110		1	30		100				2	2	30		100				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 Brand, Specialty Tier, Vaccines										1		
H0524	046	0	1	01	01	H0524_046_0	7	Preferred Brand	4	000001	1	2	3	1	110		01	110		1	30		100				2	2	30		100				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 Brand, Specialty Tier, Vaccines												
H0524	046	0	1	01	01	H0524_046_0	7	Non-Preferred Brand	4	100000	1	2	4	1	110		01	110		1	30		100				2	2	30		100				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 Brand, Specialty Tier, Vaccines												
H0524	046	0	1	01	01	H0524_046_0	7	Specialty Tier	4	010010	1	1	5	1	110		01	110		1	30		100				2	2	30		100				30		31				1692.00	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	7	Vaccines	4	000001	1	2	6	1	010		01			1	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	7	Vaccines	4	000001	1	2	6	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	7	Preferred Generic	4	001000	1	2	1	1	110		01	110		1	30		100				2	2	30		100				30		31	6.00		18.00																			6.00		12.00																6.00				6.00		0.20			0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	051	0	1	01	01	H0524_051_0	7	Preferred Generic	4	001000	1	2	1	3	110		01	110		1	30		100				2	2	30		100				30		31	6.00		18.00																			6.00		12.00																6.00				6.00		0.20			0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	051	0	1	01	01	H0524_051_0	7	Generic	4	010000	1	2	2	1	110		01	110		1	30		100				2	2	30		100				30		31	20.00		60.00																			20.00		40.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0524	051	0	1	01	01	H0524_051_0	7	Generic	4	010000	1	2	2	3	110		01	110		1	30		100				2	2	30		100				30		31	20.00		60.00																			20.00		40.00																20.00				20.00		0.66			0.66			0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0524	051	0	1	01	01	H0524_051_0	7	Preferred Brand	4	000001	1	2	3	1	110		01	110		1	30		100				2	2	30		100				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 Brand, Specialty Tier, Vaccines												
H0524	051	0	1	01	01	H0524_051_0	7	Non-Preferred Brand	4	100000	1	2	4	1	110		01	110		1	30		100				2	2	30		100				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 Brand, Specialty Tier, Vaccines												
H0524	051	0	1	01	01	H0524_051_0	7	Specialty Tier	4	010010	1	1	5	1	110		01	110		1	30		100				2	2	30		100				30		31				2157.00	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	7	Vaccines	4	000001	1	2	6	1	010		01			1	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	7	Vaccines	4	000001	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0543	001	0	1	01	01	H0543_001_0	5	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	001	0	1	01	01	H0543_001_0	5	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	001	0	1	01	01	H0543_001_0	5	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	001	0	1	01	01	H0543_001_0	5	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	001	0	1	01	01	H0543_001_0	5	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				928.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	004	0	1	01	01	H0543_004_0	5	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	004	0	1	01	01	H0543_004_0	5	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	004	0	1	01	01	H0543_004_0	5	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		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	004	0	1	01	01	H0543_004_0	5	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		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	004	0	1	01	01	H0543_004_0	5	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				796.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	007	0	1	01	01	H0543_007_0	5	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	007	0	1	01	01	H0543_007_0	5	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	007	0	1	01	01	H0543_007_0	5	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		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	007	0	1	01	01	H0543_007_0	5	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		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	007	0	1	01	01	H0543_007_0	5	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				1025.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	013	0	1	01	01	H0543_013_0	5	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	013	0	1	01	01	H0543_013_0	5	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	013	0	1	01	01	H0543_013_0	5	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	013	0	1	01	01	H0543_013_0	5	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	013	0	1	01	01	H0543_013_0	5	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				728.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	019	0	1	01	01	H0543_019_0	5	Preferred Generic	3	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	15.00		45.00																											45.00						0.00				15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	019	0	1	01	01	H0543_019_0	5	Generic	3	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	20.00		60.00																											60.00						0.00				20.00				20.00		0.66						0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	019	0	1	01	01	H0543_019_0	5	Preferred Brand	3	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	019	0	1	01	01	H0543_019_0	5	Non-Preferred Drug	3	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	019	0	1	01	01	H0543_019_0	5	Specialty Tier	3	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				934.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	022	0	1	01	01	H0543_022_0	5	Preferred Generic	3	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	022	0	1	01	01	H0543_022_0	5	Generic	3	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	022	0	1	01	01	H0543_022_0	5	Preferred Brand	3	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	022	0	1	01	01	H0543_022_0	5	Non-Preferred Drug	3	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	022	0	1	01	01	H0543_022_0	5	Specialty Tier	3	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				720.00	27		27																										27						27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	028	0	1	01	01	H0543_028_0	5	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	028	0	1	01	01	H0543_028_0	5	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		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	01	01	H0543_028_0	5	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	028	0	1	01	01	H0543_028_0	5	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	028	0	1	01	01	H0543_028_0	5	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				640.00	25		25																										25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	029	0	1	01	01	H0543_029_0	5	Preferred Generic	3	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	029	0	1	01	01	H0543_029_0	5	Generic	3	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		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	01	01	H0543_029_0	5	Preferred Brand	3	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	029	0	1	01	01	H0543_029_0	5	Non-Preferred Drug	3	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	029	0	1	01	01	H0543_029_0	5	Specialty Tier	3	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				575.00	26		26																										26						26			26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	032	0	1	01	01	H0543_032_0	5	Preferred Generic	3	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	032	0	1	01	01	H0543_032_0	5	Generic	3	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	032	0	1	01	01	H0543_032_0	5	Preferred Brand	3	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	032	0	1	01	01	H0543_032_0	5	Non-Preferred Drug	3	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	032	0	1	01	01	H0543_032_0	5	Specialty Tier	3	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				727.00	26		26																										26						26			26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	035	0	1	01	01	H0543_035_0	5	Preferred Generic	3	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	035	0	1	01	01	H0543_035_0	5	Generic	3	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		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	01	01	H0543_035_0	5	Preferred Brand	3	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	035	0	1	01	01	H0543_035_0	5	Non-Preferred Drug	3	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	035	0	1	01	01	H0543_035_0	5	Specialty Tier	3	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				747.00	26		26																										26						26			26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	036	0	1	01	01	H0543_036_0	5	Preferred Generic	3	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	036	0	1	01	01	H0543_036_0	5	Generic	3	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		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	01	01	H0543_036_0	5	Preferred Brand	3	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	036	0	1	01	01	H0543_036_0	5	Non-Preferred Drug	3	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	036	0	1	01	01	H0543_036_0	5	Specialty Tier	3	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				739.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	060	0	1	01	01	H0543_060_0	5	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	060	0	1	01	01	H0543_060_0	5	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	060	0	1	01	01	H0543_060_0	5	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	060	0	1	01	01	H0543_060_0	5	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	060	0	1	01	01	H0543_060_0	5	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				781.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	070	0	1	01	01	H0543_070_0	5	Preferred Generic	3	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	070	0	1	01	01	H0543_070_0	5	Generic	3	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		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	01	01	H0543_070_0	5	Preferred Brand	3	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	070	0	1	01	01	H0543_070_0	5	Non-Preferred Drug	3	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	070	0	1	01	01	H0543_070_0	5	Specialty Tier	3	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				698.00	26		26																										26						26			26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	086	0	1	01	01	H0543_086_0	5	Preferred Generic	3	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	086	0	1	01	01	H0543_086_0	5	Generic	3	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		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	01	01	H0543_086_0	5	Preferred Brand	3	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	086	0	1	01	01	H0543_086_0	5	Non-Preferred Drug	3	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	086	0	1	01	01	H0543_086_0	5	Specialty Tier	3	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				877.00	26		26																										26						26			26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	089	0	1	01	01	H0543_089_0	5	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	089	0	1	01	01	H0543_089_0	5	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	089	0	1	01	01	H0543_089_0	5	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	089	0	1	01	01	H0543_089_0	5	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	089	0	1	01	01	H0543_089_0	5	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				670.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	138	0	1	01	01	H0543_138_0	5	Preferred Generic	4	001000	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	138	0	1	01	01	H0543_138_0	5	Preferred Generic	4	001000	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	138	0	1	01	01	H0543_138_0	5	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	7.00		21.00																											21.00						0.00				7.00				7.00		0.23						0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	138	0	1	01	01	H0543_138_0	5	Generic	4	010000	1	2	2	3	110		01		100	1	30		90				1	2						90	30		31	7.00		21.00																											21.00						0.00				7.00				7.00		0.23						0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	138	0	1	01	01	H0543_138_0	5	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	138	0	1	01	01	H0543_138_0	5	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	138	0	1	01	01	H0543_138_0	5	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				896.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	140	0	1	01	01	H0543_140_0	5	Preferred Generic	3	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	140	0	1	01	01	H0543_140_0	5	Generic	3	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		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	01	01	H0543_140_0	5	Preferred Brand	3	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	140	0	1	01	01	H0543_140_0	5	Non-Preferred Drug	3	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	140	0	1	01	01	H0543_140_0	5	Specialty Tier	3	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				742.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	144	0	1	01	01	H0543_144_0	5	Preferred Generic	4	001000	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	144	0	1	01	01	H0543_144_0	5	Preferred Generic	4	001000	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	144	0	1	01	01	H0543_144_0	5	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	7.00		21.00																											21.00						0.00				7.00				7.00		0.23						0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	144	0	1	01	01	H0543_144_0	5	Generic	4	010000	1	2	2	3	110		01		100	1	30		90				1	2						90	30		31	7.00		21.00																											21.00						0.00				7.00				7.00		0.23						0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	144	0	1	01	01	H0543_144_0	5	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	144	0	1	01	01	H0543_144_0	5	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	144	0	1	01	01	H0543_144_0	5	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				942.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	145	0	1	01	01	H0543_145_0	5	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	145	0	1	01	01	H0543_145_0	5	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	145	0	1	01	01	H0543_145_0	5	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	145	0	1	01	01	H0543_145_0	5	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	145	0	1	01	01	H0543_145_0	5	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				836.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	146	0	1	01	01	H0543_146_0	5	Preferred Generic	3	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	146	0	1	01	01	H0543_146_0	5	Generic	3	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		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	01	01	H0543_146_0	5	Preferred Brand	3	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	146	0	1	01	01	H0543_146_0	5	Non-Preferred Drug	3	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	146	0	1	01	01	H0543_146_0	5	Specialty Tier	3	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				670.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	147	0	1	01	01	H0543_147_0	5	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	147	0	1	01	01	H0543_147_0	5	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		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	01	01	H0543_147_0	5	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	147	0	1	01	01	H0543_147_0	5	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	147	0	1	01	01	H0543_147_0	5	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				625.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	148	0	1	01	01	H0543_148_0	5	Preferred Generic	3	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	148	0	1	01	01	H0543_148_0	5	Generic	3	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		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	01	01	H0543_148_0	5	Preferred Brand	3	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	148	0	1	01	01	H0543_148_0	5	Non-Preferred Drug	3	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	148	0	1	01	01	H0543_148_0	5	Specialty Tier	3	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				1130.00	27		27																										27						27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	151	0	1	01	01	H0543_151_0	5	Preferred Generic	4	001000	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	151	0	1	01	01	H0543_151_0	5	Preferred Generic	4	001000	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	151	0	1	01	01	H0543_151_0	5	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	7.00		21.00																											21.00						0.00				7.00				7.00		0.23						0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	151	0	1	01	01	H0543_151_0	5	Generic	4	010000	1	2	2	3	110		01		100	1	30		90				1	2						90	30		31	7.00		21.00																											21.00						0.00				7.00				7.00		0.23						0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0543	151	0	1	01	01	H0543_151_0	5	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	151	0	1	01	01	H0543_151_0	5	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	151	0	1	01	01	H0543_151_0	5	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				846.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	152	0	1	01	01	H0543_152_0	5	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	5.00		15.00																											15.00						0.00				5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	152	0	1	01	01	H0543_152_0	5	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	9.00		27.00																											27.00						0.00				9.00				9.00		0.30						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	152	0	1	01	01	H0543_152_0	5	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	152	0	1	01	01	H0543_152_0	5	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0543	152	0	1	01	01	H0543_152_0	5	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				761.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0544	002	0	1	01	01	H0544_002_0	8	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	002	0	1	01	01	H0544_002_0	8	Preferred Generic	4	001000	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	002	0	1	01	01	H0544_002_0	8	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	9.50		28.50																					23.75																9.50				9.50		0.32						0.31	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	002	0	1	01	01	H0544_002_0	8	Generic	4	010000	1	2	2	3	110		01	100		1	30		90				1	2			90				30		31	9.50		28.50																					23.75																9.50				9.50		0.32						0.31	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	002	0	1	01	01	H0544_002_0	8	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	37.50		112.50																					93.75																37.50				37.50		1.25						1.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	002	0	1	01	01	H0544_002_0	8	Non-Preferred Drug	4	100100	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	85.00		255.00																					212.50																85.00				85.00		2.83						2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	002	0	1	01	01	H0544_002_0	8	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31				538.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	002	0	1	01	01	H0544_002_0	8	Select Care Drugs	4	010010	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	002	0	1	01	01	H0544_002_0	8	Select Care Drugs	4	010010	1	2	6	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	003	0	1	01	01	H0544_003_0	7	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	003	0	1	01	01	H0544_003_0	7	Preferred Generic	4	001000	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	003	0	1	01	01	H0544_003_0	7	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	003	0	1	01	01	H0544_003_0	7	Generic	4	010000	1	2	2	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	003	0	1	01	01	H0544_003_0	7	Preferred Brand	4	000001	1	1	3	1	110		01	100		1	30		90				1	2			90				30		31				3.89	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	003	0	1	01	01	H0544_003_0	7	Non-Preferred Drug	4	100100	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				3.32	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	003	0	1	01	01	H0544_003_0	7	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31				2.40	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	003	0	1	01	01	H0544_003_0	7	Select Care Drugs	4	010010	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	003	0	1	01	01	H0544_003_0	7	Select Care Drugs	4	010010	1	2	6	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	004	0	1	01	01	H0544_004_0	9	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	004	0	1	01	01	H0544_004_0	9	Preferred Generic	4	001000	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	004	0	1	01	01	H0544_004_0	9	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	9.50		28.50																					23.75																9.50				9.50		0.32						0.31	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	004	0	1	01	01	H0544_004_0	9	Generic	4	010000	1	2	2	3	110		01	100		1	30		90				1	2			90				30		31	9.50		28.50																					23.75																9.50				9.50		0.32						0.31	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	004	0	1	01	01	H0544_004_0	9	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	37.50		112.50																					93.75																37.50				37.50		1.25						1.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	004	0	1	01	01	H0544_004_0	9	Non-Preferred Drug	4	100100	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	85.00		255.00																					212.50																85.00				85.00		2.83						2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	004	0	1	01	01	H0544_004_0	9	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31				538.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	004	0	1	01	01	H0544_004_0	9	Select Care Drugs	4	010010	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	004	0	1	01	01	H0544_004_0	9	Select Care Drugs	4	010010	1	2	6	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	005	0	1	01	01	H0544_005_0	9	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	005	0	1	01	01	H0544_005_0	9	Preferred Generic	4	001000	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	005	0	1	01	01	H0544_005_0	9	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	9.50		28.50																					23.75																9.50				9.50		0.32						0.31	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	005	0	1	01	01	H0544_005_0	9	Generic	4	010000	1	2	2	3	110		01	100		1	30		90				1	2			90				30		31	9.50		28.50																					23.75																9.50				9.50		0.32						0.31	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	005	0	1	01	01	H0544_005_0	9	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	37.50		112.50																					93.75																37.50				37.50		1.25						1.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	005	0	1	01	01	H0544_005_0	9	Non-Preferred Drug	4	100100	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	85.00		255.00																					212.50																85.00				85.00		2.83						2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	005	0	1	01	01	H0544_005_0	9	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31				538.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	005	0	1	01	01	H0544_005_0	9	Select Care Drugs	4	010010	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	005	0	1	01	01	H0544_005_0	9	Select Care Drugs	4	010010	1	2	6	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	007	0	1	01	01	H0544_007_0	9	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	5.00		15.00																					12.50																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	007	0	1	01	01	H0544_007_0	9	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	14.50		43.50																					36.25																14.50				14.50		0.48						0.47	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	007	0	1	01	01	H0544_007_0	9	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	45.00		135.00																					112.50																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	007	0	1	01	01	H0544_007_0	9	Non-Preferred Drug	4	100100	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	95.00		285.00																					237.50																95.00				95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	007	0	1	01	01	H0544_007_0	9	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31				538.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	007	0	1	01	01	H0544_007_0	9	Select Care Drugs	4	010010	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	10.00		30.00																					25.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	008	0	1	01	01	H0544_008_0	7	Preferred Generic	4	001000	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	008	0	1	01	01	H0544_008_0	7	Preferred Generic	4	001000	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	008	0	1	01	01	H0544_008_0	7	Generic	4	010000	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								14.50		43.50					9.50		28.50							23.75																14.50				14.50			0.48	0.32				0.47	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	008	0	1	01	01	H0544_008_0	7	Generic	4	010000	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								14.50		43.50					9.50		28.50							23.75																14.50				14.50			0.48	0.32				0.47	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	008	0	1	01	01	H0544_008_0	7	Preferred Brand	4	000001	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								45.00		135.00					40.00		120.00							100.00																45.00				45.00			1.50	1.33				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	008	0	1	01	01	H0544_008_0	7	Non-Preferred Drug	4	100100	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								95.00		285.00					85.00		255.00							212.50																95.00				95.00			3.17	2.83				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	008	0	1	01	01	H0544_008_0	7	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		31											538.00	33						538.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	008	0	1	01	01	H0544_008_0	7	Select Care Drugs	4	010010	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	008	0	1	01	01	H0544_008_0	7	Select Care Drugs	4	010010	1	2	6	3		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H0544	010	0	1	01	01	H0544_010_0	8	Preferred Generic	4	001000	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	010	0	1	01	01	H0544_010_0	8	Preferred Generic	4	001000	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	010	0	1	01	01	H0544_010_0	8	Generic	4	010000	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								14.50		43.50					9.50		28.50							23.75																14.50				14.50			0.48	0.32				0.47	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	010	0	1	01	01	H0544_010_0	8	Generic	4	010000	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								14.50		43.50					9.50		28.50							23.75																14.50				14.50			0.48	0.32				0.47	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	010	0	1	01	01	H0544_010_0	8	Preferred Brand	4	000001	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								45.00		135.00					40.00		120.00							100.00																45.00				45.00			1.50	1.33				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	010	0	1	01	01	H0544_010_0	8	Non-Preferred Drug	4	100100	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								95.00		285.00					85.00		255.00							212.50																95.00				95.00			3.17	2.83				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	010	0	1	01	01	H0544_010_0	8	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		31											538.00	33						538.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	010	0	1	01	01	H0544_010_0	8	Select Care Drugs	4	010010	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	010	0	1	01	01	H0544_010_0	8	Select Care Drugs	4	010010	1	2	6	3		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H0544	012	0	1	01	01	H0544_012_0	7	Preferred Generic	4	001000	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	012	0	1	01	01	H0544_012_0	7	Preferred Generic	4	001000	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	012	0	1	01	01	H0544_012_0	7	Generic	4	010000	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								14.50		43.50					9.50		28.50							23.75																14.50				14.50			0.48	0.32				0.47	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	012	0	1	01	01	H0544_012_0	7	Generic	4	010000	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								14.50		43.50					9.50		28.50							23.75																14.50				14.50			0.48	0.32				0.47	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	012	0	1	01	01	H0544_012_0	7	Preferred Brand	4	000001	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								45.00		135.00					40.00		120.00							100.00																45.00				45.00			1.50	1.33				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	012	0	1	01	01	H0544_012_0	7	Non-Preferred Drug	4	100100	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								95.00		285.00					85.00		255.00							212.50																95.00				95.00			3.17	2.83				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	012	0	1	01	01	H0544_012_0	7	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		31											538.00	33						538.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	012	0	1	01	01	H0544_012_0	7	Select Care Drugs	4	010010	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	012	0	1	01	01	H0544_012_0	7	Select Care Drugs	4	010010	1	2	6	3		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H0544	013	0	1	01	01	H0544_013_0	8	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	013	0	1	01	01	H0544_013_0	8	Preferred Generic	4	001000	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	013	0	1	01	01	H0544_013_0	8	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	9.50		28.50																					23.75																9.50				9.50		0.32						0.31	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	013	0	1	01	01	H0544_013_0	8	Generic	4	010000	1	2	2	3	110		01	100		1	30		90				1	2			90				30		31	9.50		28.50																					23.75																9.50				9.50		0.32						0.31	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	013	0	1	01	01	H0544_013_0	8	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	37.50		112.50																					93.75																37.50				37.50		1.25						1.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	013	0	1	01	01	H0544_013_0	8	Non-Preferred Drug	4	100100	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	85.00		255.00																					212.50																85.00				85.00		2.83						2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	013	0	1	01	01	H0544_013_0	8	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31				538.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	013	0	1	01	01	H0544_013_0	8	Select Care Drugs	4	010010	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	013	0	1	01	01	H0544_013_0	8	Select Care Drugs	4	010010	1	2	6	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	014	0	1	01	01	H0544_014_0	8	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	014	0	1	01	01	H0544_014_0	8	Preferred Generic	4	001000	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	014	0	1	01	01	H0544_014_0	8	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	9.50		28.50																					23.75																9.50				9.50		0.32						0.31	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	014	0	1	01	01	H0544_014_0	8	Generic	4	010000	1	2	2	3	110		01	100		1	30		90				1	2			90				30		31	9.50		28.50																					23.75																9.50				9.50		0.32						0.31	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	014	0	1	01	01	H0544_014_0	8	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	37.50		112.50																					93.75																37.50				37.50		1.25						1.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	014	0	1	01	01	H0544_014_0	8	Non-Preferred Drug	4	100100	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	85.00		255.00																					212.50																85.00				85.00		2.83						2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	014	0	1	01	01	H0544_014_0	8	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31				538.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	014	0	1	01	01	H0544_014_0	8	Select Care Drugs	4	010010	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	014	0	1	01	01	H0544_014_0	8	Select Care Drugs	4	010010	1	2	6	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	015	0	1	01	01	H0544_015_0	8	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	015	0	1	01	01	H0544_015_0	8	Preferred Generic	4	001000	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	015	0	1	01	01	H0544_015_0	8	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	9.50		28.50																					23.75																9.50				9.50		0.32						0.31	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	015	0	1	01	01	H0544_015_0	8	Generic	4	010000	1	2	2	3	110		01	100		1	30		90				1	2			90				30		31	9.50		28.50																					23.75																9.50				9.50		0.32						0.31	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	015	0	1	01	01	H0544_015_0	8	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	37.50		112.50																					93.75																37.50				37.50		1.25						1.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	015	0	1	01	01	H0544_015_0	8	Non-Preferred Drug	4	100100	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	85.00		255.00																					212.50																85.00				85.00		2.83						2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	015	0	1	01	01	H0544_015_0	8	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31				538.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	015	0	1	01	01	H0544_015_0	8	Select Care Drugs	4	010010	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	015	0	1	01	01	H0544_015_0	8	Select Care Drugs	4	010010	1	2	6	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	019	0	1	01	01	H0544_019_0	7	Preferred Generic	4	001000	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	019	0	1	01	01	H0544_019_0	7	Preferred Generic	4	001000	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	019	0	1	01	01	H0544_019_0	7	Generic	4	010000	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								14.50		43.50					9.50		28.50							23.75																14.50				14.50			0.48	0.32				0.47	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	019	0	1	01	01	H0544_019_0	7	Generic	4	010000	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								14.50		43.50					9.50		28.50							23.75																14.50				14.50			0.48	0.32				0.47	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	019	0	1	01	01	H0544_019_0	7	Preferred Brand	4	000001	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								45.00		135.00					40.00		120.00							100.00																45.00				45.00			1.50	1.33				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	019	0	1	01	01	H0544_019_0	7	Non-Preferred Drug	4	100100	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								95.00		285.00					85.00		255.00							212.50																95.00				95.00			3.17	2.83				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	019	0	1	01	01	H0544_019_0	7	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		31											538.00	33						538.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	019	0	1	01	01	H0544_019_0	7	Select Care Drugs	4	010010	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	019	0	1	01	01	H0544_019_0	7	Select Care Drugs	4	010010	1	2	6	3		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H0544	020	0	1	01	01	H0544_020_0	7	Preferred Generic	4	001000	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	020	0	1	01	01	H0544_020_0	7	Preferred Generic	4	001000	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	020	0	1	01	01	H0544_020_0	7	Generic	4	010000	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								14.50		43.50					9.50		28.50							23.75																14.50				14.50			0.48	0.32				0.47	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	020	0	1	01	01	H0544_020_0	7	Generic	4	010000	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								14.50		43.50					9.50		28.50							23.75																14.50				14.50			0.48	0.32				0.47	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	020	0	1	01	01	H0544_020_0	7	Preferred Brand	4	000001	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								45.00		135.00					40.00		120.00							100.00																45.00				45.00			1.50	1.33				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	020	0	1	01	01	H0544_020_0	7	Non-Preferred Drug	4	100100	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								95.00		285.00					85.00		255.00							212.50																95.00				95.00			3.17	2.83				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	020	0	1	01	01	H0544_020_0	7	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		31											538.00	33						538.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	020	0	1	01	01	H0544_020_0	7	Select Care Drugs	4	010010	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	020	0	1	01	01	H0544_020_0	7	Select Care Drugs	4	010010	1	2	6	3		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H0544	021	0	1	01	01	H0544_021_0	8	Preferred Generic	4	001000	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								10.00		30.00					5.00		15.00							12.50																10.00				10.00			0.33	0.17				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	021	0	1	01	01	H0544_021_0	8	Generic	4	010000	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								17.50		52.50					12.50		37.50							31.25																17.50				17.50			0.58	0.42				0.56	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	021	0	1	01	01	H0544_021_0	8	Preferred Brand	4	000001	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								45.00		135.00					40.00		120.00							100.00																45.00				45.00			1.50	1.33				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	021	0	1	01	01	H0544_021_0	8	Non-Preferred Drug	4	100100	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								95.00		285.00					90.00		270.00							225.00																95.00				95.00			3.17	3.00				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	021	0	1	01	01	H0544_021_0	8	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		31											538.00	33						538.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	021	0	1	01	01	H0544_021_0	8	Select Care Drugs	4	010010	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								10.00		30.00					10.00		30.00							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												
H0544	024	0	1	01	01	H0544_024_0	7	Preferred Generic	4	001000	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	024	0	1	01	01	H0544_024_0	7	Preferred Generic	4	001000	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	024	0	1	01	01	H0544_024_0	7	Generic	4	010000	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								14.50		43.50					9.50		28.50							23.75																14.50				14.50			0.48	0.32				0.47	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	024	0	1	01	01	H0544_024_0	7	Generic	4	010000	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								14.50		43.50					9.50		28.50							23.75																14.50				14.50			0.48	0.32				0.47	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	024	0	1	01	01	H0544_024_0	7	Preferred Brand	4	000001	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								45.00		135.00					40.00		120.00							100.00																45.00				45.00			1.50	1.33				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	024	0	1	01	01	H0544_024_0	7	Non-Preferred Drug	4	100100	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								95.00		285.00					85.00		255.00							212.50																95.00				95.00			3.17	2.83				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	024	0	1	01	01	H0544_024_0	7	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		31											538.00	33						538.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	024	0	1	01	01	H0544_024_0	7	Select Care Drugs	4	010010	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	024	0	1	01	01	H0544_024_0	7	Select Care Drugs	4	010010	1	2	6	3		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H0544	025	0	1	01	01	H0544_025_0	9	Preferred Generic	4	001000	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	025	0	1	01	01	H0544_025_0	9	Preferred Generic	4	001000	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	025	0	1	01	01	H0544_025_0	9	Generic	4	010000	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								14.50		43.50					9.50		28.50							23.75																14.50				14.50			0.48	0.32				0.47	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	025	0	1	01	01	H0544_025_0	9	Generic	4	010000	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								14.50		43.50					9.50		28.50							23.75																14.50				14.50			0.48	0.32				0.47	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	025	0	1	01	01	H0544_025_0	9	Preferred Brand	4	000001	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								45.00		135.00					40.00		120.00							100.00																45.00				45.00			1.50	1.33				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	025	0	1	01	01	H0544_025_0	9	Non-Preferred Drug	4	100100	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								95.00		285.00					85.00		255.00							212.50																95.00				95.00			3.17	2.83				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	025	0	1	01	01	H0544_025_0	9	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		31											538.00	33						538.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	025	0	1	01	01	H0544_025_0	9	Select Care Drugs	4	010010	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	025	0	1	01	01	H0544_025_0	9	Select Care Drugs	4	010010	1	2	6	3		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H0544	027	0	1	01	01	H0544_027_0	8	Preferred Generic	4	001000	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	027	0	1	01	01	H0544_027_0	8	Preferred Generic	4	001000	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	027	0	1	01	01	H0544_027_0	8	Generic	4	010000	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								14.50		43.50					9.50		28.50							23.75																14.50				14.50			0.48	0.32				0.47	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	027	0	1	01	01	H0544_027_0	8	Generic	4	010000	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								14.50		43.50					9.50		28.50							23.75																14.50				14.50			0.48	0.32				0.47	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	027	0	1	01	01	H0544_027_0	8	Preferred Brand	4	000001	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								45.00		135.00					40.00		120.00							100.00																45.00				45.00			1.50	1.33				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	027	0	1	01	01	H0544_027_0	8	Non-Preferred Drug	4	100100	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								95.00		285.00					85.00		255.00							212.50																95.00				95.00			3.17	2.83				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	027	0	1	01	01	H0544_027_0	8	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		31											538.00	33						538.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	027	0	1	01	01	H0544_027_0	8	Select Care Drugs	4	010010	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	027	0	1	01	01	H0544_027_0	8	Select Care Drugs	4	010010	1	2	6	3		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H0544	031	0	1	01	01	H0544_031_0	8	Preferred Generic	4	001000	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	031	0	1	01	01	H0544_031_0	8	Preferred Generic	4	001000	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	031	0	1	01	01	H0544_031_0	8	Generic	4	010000	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								14.50		43.50					9.50		28.50							23.75																14.50				14.50			0.48	0.32				0.47	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	031	0	1	01	01	H0544_031_0	8	Generic	4	010000	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								14.50		43.50					9.50		28.50							23.75																14.50				14.50			0.48	0.32				0.47	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	031	0	1	01	01	H0544_031_0	8	Preferred Brand	4	000001	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								45.00		135.00					40.00		120.00							100.00																45.00				45.00			1.50	1.33				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	031	0	1	01	01	H0544_031_0	8	Non-Preferred Drug	4	100100	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								95.00		285.00					85.00		255.00							212.50																95.00				95.00			3.17	2.83				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	031	0	1	01	01	H0544_031_0	8	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		31											538.00	33						538.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	031	0	1	01	01	H0544_031_0	8	Select Care Drugs	4	010010	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	031	0	1	01	01	H0544_031_0	8	Select Care Drugs	4	010010	1	2	6	3		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H0544	032	0	1	01	01	H0544_032_0	8	Preferred Generic	4	001000	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	032	0	1	01	01	H0544_032_0	8	Preferred Generic	4	001000	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	032	0	1	01	01	H0544_032_0	8	Generic	4	010000	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								14.50		43.50					9.50		28.50							23.75																14.50				14.50			0.48	0.32				0.47	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	032	0	1	01	01	H0544_032_0	8	Generic	4	010000	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								14.50		43.50					9.50		28.50							23.75																14.50				14.50			0.48	0.32				0.47	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	032	0	1	01	01	H0544_032_0	8	Preferred Brand	4	000001	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								45.00		135.00					40.00		120.00							100.00																45.00				45.00			1.50	1.33				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	032	0	1	01	01	H0544_032_0	8	Non-Preferred Drug	4	100100	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								95.00		285.00					85.00		255.00							212.50																95.00				95.00			3.17	2.83				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	032	0	1	01	01	H0544_032_0	8	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		31											538.00	33						538.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	032	0	1	01	01	H0544_032_0	8	Select Care Drugs	4	010010	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	032	0	1	01	01	H0544_032_0	8	Select Care Drugs	4	010010	1	2	6	3		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H0544	036	0	1	01	01	H0544_036_0	8	Preferred Generic	4	001000	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	036	0	1	01	01	H0544_036_0	8	Preferred Generic	4	001000	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	036	0	1	01	01	H0544_036_0	8	Generic	4	010000	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								14.50		43.50					9.50		28.50							23.75																14.50				14.50			0.48	0.32				0.47	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	036	0	1	01	01	H0544_036_0	8	Generic	4	010000	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								14.50		43.50					9.50		28.50							23.75																14.50				14.50			0.48	0.32				0.47	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	036	0	1	01	01	H0544_036_0	8	Preferred Brand	4	000001	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								45.00		135.00					40.00		120.00							100.00																45.00				45.00			1.50	1.33				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	036	0	1	01	01	H0544_036_0	8	Non-Preferred Drug	4	100100	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								95.00		285.00					85.00		255.00							212.50																95.00				95.00			3.17	2.83				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	036	0	1	01	01	H0544_036_0	8	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		31											538.00	33						538.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	036	0	1	01	01	H0544_036_0	8	Select Care Drugs	4	010010	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	036	0	1	01	01	H0544_036_0	8	Select Care Drugs	4	010010	1	2	6	3		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H0544	037	0	1	01	01	H0544_037_0	8	Preferred Generic	4	001000	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	037	0	1	01	01	H0544_037_0	8	Preferred Generic	4	001000	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	037	0	1	01	01	H0544_037_0	8	Generic	4	010000	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								14.50		43.50					9.50		28.50							23.75																14.50				14.50			0.48	0.32				0.47	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	037	0	1	01	01	H0544_037_0	8	Generic	4	010000	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								14.50		43.50					9.50		28.50							23.75																14.50				14.50			0.48	0.32				0.47	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	037	0	1	01	01	H0544_037_0	8	Preferred Brand	4	000001	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								45.00		135.00					40.00		120.00							100.00																45.00				45.00			1.50	1.33				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	037	0	1	01	01	H0544_037_0	8	Non-Preferred Drug	4	100100	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								95.00		285.00					85.00		255.00							212.50																95.00				95.00			3.17	2.83				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	037	0	1	01	01	H0544_037_0	8	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		31											538.00	33						538.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	037	0	1	01	01	H0544_037_0	8	Select Care Drugs	4	010010	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	037	0	1	01	01	H0544_037_0	8	Select Care Drugs	4	010010	1	2	6	3		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H0544	038	0	1	01	01	H0544_038_0	8	Preferred Generic	4	001000	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	038	0	1	01	01	H0544_038_0	8	Preferred Generic	4	001000	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	038	0	1	01	01	H0544_038_0	8	Generic	4	010000	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								14.50		43.50					9.50		28.50							23.75																14.50				14.50			0.48	0.32				0.47	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	038	0	1	01	01	H0544_038_0	8	Generic	4	010000	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								14.50		43.50					9.50		28.50							23.75																14.50				14.50			0.48	0.32				0.47	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	038	0	1	01	01	H0544_038_0	8	Preferred Brand	4	000001	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								45.00		135.00					40.00		120.00							100.00																45.00				45.00			1.50	1.33				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	038	0	1	01	01	H0544_038_0	8	Non-Preferred Drug	4	100100	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								95.00		285.00					85.00		255.00							212.50																95.00				95.00			3.17	2.83				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	038	0	1	01	01	H0544_038_0	8	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		31											538.00	33						538.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	038	0	1	01	01	H0544_038_0	8	Select Care Drugs	4	010010	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	038	0	1	01	01	H0544_038_0	8	Select Care Drugs	4	010010	1	2	6	3		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H0544	041	0	1	01	01	H0544_041_0	8	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	041	0	1	01	01	H0544_041_0	8	Preferred Generic	4	001000	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	041	0	1	01	01	H0544_041_0	8	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	041	0	1	01	01	H0544_041_0	8	Generic	4	010000	1	2	2	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	041	0	1	01	01	H0544_041_0	8	Preferred Brand	4	000001	1	1	3	1	110		01	100		1	30		90				1	2			90				30		31				3.89	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	041	0	1	01	01	H0544_041_0	8	Non-Preferred Drug	4	100100	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				3.32	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	041	0	1	01	01	H0544_041_0	8	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31				2.40	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	041	0	1	01	01	H0544_041_0	8	Select Care Drugs	4	010010	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	041	0	1	01	01	H0544_041_0	8	Select Care Drugs	4	010010	1	2	6	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	050	0	1	01	01	H0544_050_0	7	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	050	0	1	01	01	H0544_050_0	7	Preferred Generic	4	001000	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	050	0	1	01	01	H0544_050_0	7	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	9.50		28.50																					23.75																9.50				9.50		0.32						0.31	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	050	0	1	01	01	H0544_050_0	7	Generic	4	010000	1	2	2	3	110		01	100		1	30		90				1	2			90				30		31	9.50		28.50																					23.75																9.50				9.50		0.32						0.31	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0544	050	0	1	01	01	H0544_050_0	7	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	40.00		120.00																					100.00																40.00				40.00		1.33						1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	050	0	1	01	01	H0544_050_0	7	Non-Preferred Drug	4	100100	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	85.00		255.00																					212.50																85.00				85.00		2.83						2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	050	0	1	01	01	H0544_050_0	7	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31				538.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	050	0	1	01	01	H0544_050_0	7	Select Care Drugs	4	010010	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0544	050	0	1	01	01	H0544_050_0	7	Select Care Drugs	4	010010	1	2	6	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H0545	001	0	1	01	01	H0545_001_0	11	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				2	1			90				30		31	5.00		15.00																					10.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0545	001	0	1	01	01	H0545_001_0	11	Generic	4	010000	3	2	2	1	110		01	100		1	30		90				2	1			90				30		31	12.00		36.00																					24.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0545	001	0	1	01	01	H0545_001_0	11	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				2	1			90				30		31	47.00		141.00																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0545	001	0	1	01	01	H0545_001_0	11	Non-Preferred Drug	4	100100	3	1	4	1	110		01	100		1	30		90				2	1			90				30		31				72.23	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0545	001	0	1	01	01	H0545_001_0	11	Specialty Tier	4	010010	1	1	5	1	010		01			1	30														30		31				786.24	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0545	001	0	1	01	01	H0545_001_0	11	Select Care Drugs	4	010010	1	2	6	1	110		01	100		1	30		90				2	1			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0545	012	0	1	01	01	H0545_012_0	10	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				2	1			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0545	012	0	1	01	01	H0545_012_0	10	Preferred Generic	4	001000	1	2	1	3	110		01	100		1	30		90				2	1			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H0545	012	0	1	01	01	H0545_012_0	10	Generic	4	010000	3	2	2	1	110		01	100		1	30		90				2	1			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												
H0545	012	0	1	01	01	H0545_012_0	10	Generic	4	010000	3	2	2	3	110		01	100		1	30		90				2	1			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										1		3
H0545	012	0	1	01	01	H0545_012_0	10	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				2	1			90				30		31	47.00		141.00																					141.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0545	012	0	1	01	01	H0545_012_0	10	Non-Preferred Drug	4	100100	3	1	4	1	110		01	100		1	30		90				2	1			90				30		31				51.40	30		30																				30															30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0545	012	0	1	01	01	H0545_012_0	10	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31				667.96	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0545	012	0	1	01	01	H0545_012_0	10	Select Care Drugs	4	010010	1	2	6	1	010		01	010		1	30								30						30		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, Select Care Drugs												
H0545	012	0	1	01	01	H0545_012_0	10	Select Care Drugs	4	010010	1	2	6	3	010		01	010		1	30								30						30		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, Select Care Drugs										1		
H0545	013	0	1	01	01	H0545_013_0	12	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				2	1			90				30		31	5.00		15.00																					10.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0545	013	0	1	01	01	H0545_013_0	12	Preferred Generic	4	001000	1	2	1	3	110		01	100		1	30		90				2	1			90				30		31	5.00		15.00																					10.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0545	013	0	1	01	01	H0545_013_0	12	Generic	4	010000	3	2	2	1	110		01	100		1	30		90				2	1			90				30		31	15.00		45.00																					30.00																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0545	013	0	1	01	01	H0545_013_0	12	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				2	1			90				30		31	39.00		117.00																					78.00																39.00				39.00		1.30						1.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0545	013	0	1	01	01	H0545_013_0	12	Non-Preferred Brand	4	100000	3	2	4	1	110		01	100		1	30		90				2	1			90				30		31	89.00		267.00																					178.00																89.00				89.00		2.97						2.87	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0545	013	0	1	01	01	H0545_013_0	12	Specialty Tier	4	010010	1	1	5	1	010		01			1	30														30		31				670.82	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0562	009	0	1	01	01	H0562_009_0	4	Preferred Generic	4	001000	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 Brand, Specialty Tier, Select Care Drugs												
H0562	009	0	1	01	01	H0562_009_0	4	Generic	4	010000	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	20.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	009	0	1	01	01	H0562_009_0	4	Preferred Brand	4	010001	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	101.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	009	0	1	01	01	H0562_009_0	4	Non-Preferred Brand	4	110000	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	260.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	009	0	1	01	01	H0562_009_0	4	Specialty Tier	4	010010	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												33	33	33					33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	009	0	1	01	01	H0562_009_0	4	Select Care Drugs	4	010010	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	012	0	1	01	01	H0562_012_0	4	Preferred Generic	4	001000	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	10.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	012	0	1	01	01	H0562_012_0	4	Generic	4	010000	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	24.00				20.00				20.00			0.67	0.40		0.67	0.40	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	012	0	1	01	01	H0562_012_0	4	Preferred Brand	4	010001	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	101.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	012	0	1	01	01	H0562_012_0	4	Non-Preferred Brand	4	110000	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	260.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	012	0	1	01	01	H0562_012_0	4	Specialty Tier	4	010010	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												31	31	31					31	31	31										31	31	31				31	31	31			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	012	0	1	01	01	H0562_012_0	4	Select Care Drugs	4	010010	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	039	0	1	01	01	H0562_039_0	4	Preferred Generic	4	001000	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00	24.00	36.00				7.00	14.00	14.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	039	0	1	01	01	H0562_039_0	4	Generic	4	010000	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	24.00				19.00				19.00			0.63	0.40		0.63	0.40	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	039	0	1	01	01	H0562_039_0	4	Preferred Brand	4	010001	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	101.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	039	0	1	01	01	H0562_039_0	4	Non-Preferred Brand	4	110000	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	260.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	039	0	1	01	01	H0562_039_0	4	Specialty Tier	4	010010	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												33	33	33					33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	039	0	1	01	01	H0562_039_0	4	Select Care Drugs	4	010010	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	055	0	1	01	01	H0562_055_0	4	Preferred Generic	3	001000	1	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	055	0	1	01	01	H0562_055_0	4	Generic	3	010000	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	40.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	055	0	1	01	01	H0562_055_0	4	Preferred Brand	3	010001	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	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	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	055	0	1	01	01	H0562_055_0	4	Non-Preferred Brand	3	110000	1	2	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	100.00	200.00	300.00																									100.00	200.00	300.00				100.00	200.00	290.00				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												
H0562	055	0	1	01	01	H0562_055_0	4	Specialty Tier	3	010010	1	1	5	1	111		01		111	1	30	60	90				1	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, Select Care Drugs												
H0562	055	0	1	01	01	H0562_055_0	4	Select Care Drugs	3	010010	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	068	0	1	01	01	H0562_068_0	5	Preferred Generic	4	001000	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	10.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	068	0	1	01	01	H0562_068_0	5	Generic	4	010000	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				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	068	0	1	01	01	H0562_068_0	5	Preferred Brand	4	010001	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	101.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	068	0	1	01	01	H0562_068_0	5	Non-Preferred Brand	4	110000	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	260.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	068	0	1	01	01	H0562_068_0	5	Specialty Tier	4	010010	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												33	33	33					33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	068	0	1	01	01	H0562_068_0	5	Select Care Drugs	4	010010	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	079	0	1	01	01	H0562_079_0	4	Preferred Generic	4	001000	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 Brand, Specialty Tier, Select Care Drugs												
H0562	079	0	1	01	01	H0562_079_0	4	Generic	4	010000	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				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	079	0	1	01	01	H0562_079_0	4	Preferred Brand	4	010001	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	101.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	079	0	1	01	01	H0562_079_0	4	Non-Preferred Brand	4	110000	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	260.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	079	0	1	01	01	H0562_079_0	4	Specialty Tier	4	010010	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												33	33	33					33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	079	0	1	01	01	H0562_079_0	4	Select Care Drugs	4	010010	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	084	0	1	01	01	H0562_084_0	4	Preferred Generic	4	001000	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	6.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	084	0	1	01	01	H0562_084_0	4	Generic	4	010000	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	26.00				18.00				18.00			0.60	0.43		0.60	0.43	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	084	0	1	01	01	H0562_084_0	4	Preferred Brand	4	010001	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	101.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	084	0	1	01	01	H0562_084_0	4	Non-Preferred Brand	4	110000	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	260.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	084	0	1	01	01	H0562_084_0	4	Specialty Tier	4	010010	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												33	33	33					33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	084	0	1	01	01	H0562_084_0	4	Select Care Drugs	4	010010	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	090	0	1	01	01	H0562_090_0	4	Preferred Generic	4	001000	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	090	0	1	01	01	H0562_090_0	4	Generic	4	010000	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				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	090	0	1	01	01	H0562_090_0	4	Preferred Brand	4	010001	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	101.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	090	0	1	01	01	H0562_090_0	4	Non-Preferred Brand	4	110000	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	260.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	090	0	1	01	01	H0562_090_0	4	Specialty Tier	4	010010	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												33	33	33					33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	090	0	1	01	01	H0562_090_0	4	Select Care Drugs	4	010010	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	092	0	1	01	01	H0562_092_0	4	Preferred Generic	4	001000	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 Brand, Specialty Tier, Select Care Drugs												
H0562	092	0	1	01	01	H0562_092_0	4	Preferred Generic	4	001000	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0562	092	0	1	01	01	H0562_092_0	4	Generic	4	010000	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	20.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	092	0	1	01	01	H0562_092_0	4	Generic	4	010000	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					10.00	20.00	30.00											15.00	30.00	45.00				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 Brand, Specialty Tier, Select Care Drugs										1		
H0562	092	0	1	01	01	H0562_092_0	4	Preferred Brand	4	010001	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	101.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	092	0	1	01	01	H0562_092_0	4	Non-Preferred Brand	4	110000	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	260.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	092	0	1	01	01	H0562_092_0	4	Specialty Tier	4	010010	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												33	33	33					33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	092	0	1	01	01	H0562_092_0	4	Select Care Drugs	4	010010	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	092	0	1	01	01	H0562_092_0	4	Select Care Drugs	4	010010	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0562	095	0	1	01	01	H0562_095_0	6	Preferred Generic	3	001000	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	10.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	095	0	1	01	01	H0562_095_0	6	Generic	3	010000	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				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	095	0	1	01	01	H0562_095_0	6	Preferred Brand	3	010001	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	101.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	095	0	1	01	01	H0562_095_0	6	Non-Preferred Brand	3	110000	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	260.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	095	0	1	01	01	H0562_095_0	6	Specialty Tier	3	010010	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												31	31	31					31	31	31										31	31	31				31	31	31			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	095	0	1	01	01	H0562_095_0	6	Select Care Drugs	3	010010	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	097	0	1	01	01	H0562_097_0	4	Preferred Generic	4	001000	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	6.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	097	0	1	01	01	H0562_097_0	4	Generic	4	010000	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	20.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	097	0	1	01	01	H0562_097_0	4	Preferred Brand	4	010001	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	101.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	097	0	1	01	01	H0562_097_0	4	Non-Preferred Brand	4	110000	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	260.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	097	0	1	01	01	H0562_097_0	4	Specialty Tier	4	010010	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												33	33	33					33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	097	0	1	01	01	H0562_097_0	4	Select Care Drugs	4	010010	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	100	1	1	01	01	H0562_100_1	4	Preferred Generic	4	001000	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	10.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	100	1	1	01	01	H0562_100_1	4	Preferred Generic	4	001000	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	10.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0562	100	1	1	01	01	H0562_100_1	4	Generic	4	010000	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				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	100	1	1	01	01	H0562_100_1	4	Generic	4	010000	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0562	100	1	1	01	01	H0562_100_1	4	Preferred Brand	4	010001	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	101.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	100	1	1	01	01	H0562_100_1	4	Non-Preferred Brand	4	110000	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	260.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	100	1	1	01	01	H0562_100_1	4	Specialty Tier	4	010010	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												33	33	33					33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	100	1	1	01	01	H0562_100_1	4	Select Care Drugs	4	010010	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	100	1	1	01	01	H0562_100_1	4	Select Care Drugs	4	010010	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0562	100	2	1	01	01	H0562_100_2	5	Preferred Generic	4	001000	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	10.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	100	2	1	01	01	H0562_100_2	5	Preferred Generic	4	001000	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	10.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0562	100	2	1	01	01	H0562_100_2	5	Generic	4	010000	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				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	100	2	1	01	01	H0562_100_2	5	Generic	4	010000	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0562	100	2	1	01	01	H0562_100_2	5	Preferred Brand	4	010001	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	101.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	100	2	1	01	01	H0562_100_2	5	Non-Preferred Brand	4	110000	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	260.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	100	2	1	01	01	H0562_100_2	5	Specialty Tier	4	010010	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												33	33	33					33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	100	2	1	01	01	H0562_100_2	5	Select Care Drugs	4	010010	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	100	2	1	01	01	H0562_100_2	5	Select Care Drugs	4	010010	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0562	101	1	1	01	01	H0562_101_1	4	Preferred Generic	4	001000	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 Brand, Specialty Tier, Select Care Drugs												
H0562	101	1	1	01	01	H0562_101_1	4	Preferred Generic	4	001000	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0562	101	1	1	01	01	H0562_101_1	4	Generic	4	010000	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				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	101	1	1	01	01	H0562_101_1	4	Generic	4	010000	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0562	101	1	1	01	01	H0562_101_1	4	Preferred Brand	4	010001	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	101.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	101	1	1	01	01	H0562_101_1	4	Non-Preferred Brand	4	110000	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	260.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	101	1	1	01	01	H0562_101_1	4	Specialty Tier	4	010010	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												33	33	33					33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	101	1	1	01	01	H0562_101_1	4	Select Care Drugs	4	010010	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	101	1	1	01	01	H0562_101_1	4	Select Care Drugs	4	010010	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0562	101	2	1	01	01	H0562_101_2	4	Preferred Generic	4	001000	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 Brand, Specialty Tier, Select Care Drugs												
H0562	101	2	1	01	01	H0562_101_2	4	Preferred Generic	4	001000	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0562	101	2	1	01	01	H0562_101_2	4	Generic	4	010000	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				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	101	2	1	01	01	H0562_101_2	4	Generic	4	010000	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00	40.00	60.00				10.00	20.00	20.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0562	101	2	1	01	01	H0562_101_2	4	Preferred Brand	4	010001	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	101.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	101	2	1	01	01	H0562_101_2	4	Non-Preferred Brand	4	110000	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	260.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	101	2	1	01	01	H0562_101_2	4	Specialty Tier	4	010010	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												33	33	33					33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	101	2	1	01	01	H0562_101_2	4	Select Care Drugs	4	010010	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	101	2	1	01	01	H0562_101_2	4	Select Care Drugs	4	010010	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H0562	103	0	1	01	01	H0562_103_0	4	Preferred Generic	4	001000	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								13.00	26.00	39.00					8.00	16.00	24.00											13.00	26.00	39.00				8.00	16.00	16.00				13.00				13.00			0.43	0.27		0.43	0.27	0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	103	0	1	01	01	H0562_103_0	4	Generic	4	010000	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				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	103	0	1	01	01	H0562_103_0	4	Preferred Brand	4	010001	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	101.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	103	0	1	01	01	H0562_103_0	4	Non-Preferred Brand	4	110000	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	260.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	103	0	1	01	01	H0562_103_0	4	Specialty Tier	4	010010	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												33	33	33					33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	103	0	1	01	01	H0562_103_0	4	Select Care Drugs	4	010010	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	110	1	1	01	01	H0562_110_1	4	Preferred Generic	3	001000	1	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	110	1	1	01	01	H0562_110_1	4	Generic	3	010000	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	40.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	110	1	1	01	01	H0562_110_1	4	Preferred Brand	3	010001	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	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	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	110	1	1	01	01	H0562_110_1	4	Non-Preferred Brand	3	110000	1	2	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	100.00	200.00	300.00																									100.00	200.00	300.00				100.00	200.00	290.00				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												
H0562	110	1	1	01	01	H0562_110_1	4	Specialty Tier	3	010010	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	30			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	110	1	1	01	01	H0562_110_1	4	Select Care Drugs	3	010010	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	110	2	1	01	01	H0562_110_2	4	Preferred Generic	3	001000	1	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	110	2	1	01	01	H0562_110_2	4	Generic	3	010000	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	40.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	110	2	1	01	01	H0562_110_2	4	Preferred Brand	3	010001	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	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	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	110	2	1	01	01	H0562_110_2	4	Non-Preferred Brand	3	110000	1	2	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	100.00	200.00	300.00																									100.00	200.00	300.00				100.00	200.00	290.00				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												
H0562	110	2	1	01	01	H0562_110_2	4	Specialty Tier	3	010010	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	30			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	110	2	1	01	01	H0562_110_2	4	Select Care Drugs	3	010010	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	110	3	1	01	01	H0562_110_3	4	Preferred Generic	3	001000	1	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	110	3	1	01	01	H0562_110_3	4	Generic	3	010000	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	40.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	110	3	1	01	01	H0562_110_3	4	Preferred Brand	3	010001	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	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	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	110	3	1	01	01	H0562_110_3	4	Non-Preferred Brand	3	110000	1	2	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	100.00	200.00	300.00																									100.00	200.00	300.00				100.00	200.00	290.00				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												
H0562	110	3	1	01	01	H0562_110_3	4	Specialty Tier	3	010010	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	30			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	110	3	1	01	01	H0562_110_3	4	Select Care Drugs	3	010010	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	111	1	1	01	01	H0562_111_1	4	Preferred Generic	3	001000	1	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	111	1	1	01	01	H0562_111_1	4	Generic	3	010000	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	40.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	111	1	1	01	01	H0562_111_1	4	Preferred Brand	3	010001	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	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	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	111	1	1	01	01	H0562_111_1	4	Non-Preferred Brand	3	110000	1	2	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	100.00	200.00	300.00																									100.00	200.00	300.00				100.00	200.00	290.00				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												
H0562	111	1	1	01	01	H0562_111_1	4	Specialty Tier	3	010010	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	30			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	111	1	1	01	01	H0562_111_1	4	Select Care Drugs	3	010010	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	111	2	1	01	01	H0562_111_2	4	Preferred Generic	3	001000	1	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	111	2	1	01	01	H0562_111_2	4	Generic	3	010000	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	40.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	111	2	1	01	01	H0562_111_2	4	Preferred Brand	3	010001	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	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	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	111	2	1	01	01	H0562_111_2	4	Non-Preferred Brand	3	110000	1	2	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	100.00	200.00	300.00																									100.00	200.00	300.00				100.00	200.00	290.00				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												
H0562	111	2	1	01	01	H0562_111_2	4	Specialty Tier	3	010010	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	30			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	111	2	1	01	01	H0562_111_2	4	Select Care Drugs	3	010010	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	111	3	1	01	01	H0562_111_3	4	Preferred Generic	3	001000	1	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	111	3	1	01	01	H0562_111_3	4	Generic	3	010000	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	40.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	111	3	1	01	01	H0562_111_3	4	Preferred Brand	3	010001	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	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	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	111	3	1	01	01	H0562_111_3	4	Non-Preferred Brand	3	110000	1	2	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	100.00	200.00	300.00																									100.00	200.00	300.00				100.00	200.00	290.00				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												
H0562	111	3	1	01	01	H0562_111_3	4	Specialty Tier	3	010010	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	30			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	111	3	1	01	01	H0562_111_3	4	Select Care Drugs	3	010010	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	112	0	1	01	01	H0562_112_0	4	Preferred Generic	4	001000	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	112	0	1	01	01	H0562_112_0	4	Generic	4	010000	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	10.00				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	112	0	1	01	01	H0562_112_0	4	Preferred Brand	4	010001	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	101.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	112	0	1	01	01	H0562_112_0	4	Non-Preferred Brand	4	110000	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	260.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	112	0	1	01	01	H0562_112_0	4	Specialty Tier	4	010010	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												33	33	33					33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	112	0	1	01	01	H0562_112_0	4	Select Care Drugs	4	010010	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	113	0	1	01	01	H0562_113_0	4	Preferred Generic	4	001000	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	6.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	113	0	1	01	01	H0562_113_0	4	Generic	4	010000	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	20.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	113	0	1	01	01	H0562_113_0	4	Preferred Brand	4	010001	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	101.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	113	0	1	01	01	H0562_113_0	4	Non-Preferred Brand	4	110000	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	260.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	113	0	1	01	01	H0562_113_0	4	Specialty Tier	4	010010	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												33	33	33					33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0562	113	0	1	01	01	H0562_113_0	4	Select Care Drugs	4	010010	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H0564	055	0	1	01	01	H0564_055_0	9	Preferred Generic	4	001000	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												
H0564	055	0	1	01	01	H0564_055_0	9	Generic	4	010000	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												
H0564	055	0	1	01	01	H0564_055_0	9	Preferred Brand	4	000101	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												
H0564	055	0	1	01	01	H0564_055_0	9	Non-Preferred Drug	4	100100	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												
H0564	055	0	1	01	01	H0564_055_0	9	Specialty Tier	4	010010	1	1	5	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												
H0564	055	0	1	01	01	H0564_055_0	9	Select Care Drugs	4	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0564	055	0	1	01	01	H0564_055_0	9	Select Care Drugs	4	001000	1	2	6	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		
H0564	056	0	1	01	01	H0564_056_0	7	Preferred Generic	4	001000	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												
H0564	056	0	1	01	01	H0564_056_0	7	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								8.00	16.00	24.00					8.00	16.00	24.00					8.00	24.00	24.00																8.00				8.00			0.27	0.27	0.27			0.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0564	056	0	1	01	01	H0564_056_0	7	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								45.00	90.00	135.00					45.00	90.00	135.00					45.00	135.00	135.00																45.00				45.00			1.50	1.50	1.50			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0564	056	0	1	01	01	H0564_056_0	7	Non-Preferred Drug	4	100100	1	2	4	1		111	01	111		1				30	60	90	1	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												
H0564	056	0	1	01	01	H0564_056_0	7	Specialty Tier	4	010010	1	1	5	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												
H0564	056	0	1	01	01	H0564_056_0	7	Select Care Drugs	4	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0564	056	0	1	01	01	H0564_056_0	7	Select Care Drugs	4	001000	1	2	6	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		
H0564	058	0	1	01	01	H0564_058_0	7	Preferred Generic	4	001000	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												
H0564	058	0	1	01	01	H0564_058_0	7	Generic	4	010000	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												
H0564	058	0	1	01	01	H0564_058_0	7	Preferred Brand	4	000101	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												
H0564	058	0	1	01	01	H0564_058_0	7	Non-Preferred Drug	4	100100	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												
H0564	058	0	1	01	01	H0564_058_0	7	Specialty Tier	4	010010	1	1	5	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												
H0564	058	0	1	01	01	H0564_058_0	7	Select Care Drugs	4	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0564	058	0	1	01	01	H0564_058_0	7	Select Care Drugs	4	001000	1	2	6	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		
H0564	059	0	1	01	01	H0564_059_0	7	Preferred Generic	4	001000	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												
H0564	059	0	1	01	01	H0564_059_0	7	Generic	4	010000	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												
H0564	059	0	1	01	01	H0564_059_0	7	Preferred Brand	4	000101	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												
H0564	059	0	1	01	01	H0564_059_0	7	Non-Preferred Drug	4	100100	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												
H0564	059	0	1	01	01	H0564_059_0	7	Specialty Tier	4	010010	1	1	5	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												
H0564	059	0	1	01	01	H0564_059_0	7	Select Care Drugs	4	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0564	059	0	1	01	01	H0564_059_0	7	Select Care Drugs	4	001000	1	2	6	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		
H0564	060	0	1	01	01	H0564_060_0	8	Preferred Generic	4	001000	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												
H0564	060	0	1	01	01	H0564_060_0	8	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	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												
H0564	060	0	1	01	01	H0564_060_0	8	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	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												
H0564	060	0	1	01	01	H0564_060_0	8	Non-Preferred Drug	4	100100	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												
H0564	060	0	1	01	01	H0564_060_0	8	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0564	060	0	1	01	01	H0564_060_0	8	Select Care Drugs	4	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0564	060	0	1	01	01	H0564_060_0	8	Select Care Drugs	4	001000	1	2	6	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		
H0564	061	0	1	01	01	H0564_061_0	7	Preferred Generic	4	001000	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												
H0564	061	0	1	01	01	H0564_061_0	7	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	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												
H0564	061	0	1	01	01	H0564_061_0	7	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	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												
H0564	061	0	1	01	01	H0564_061_0	7	Non-Preferred Drug	4	100100	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												
H0564	061	0	1	01	01	H0564_061_0	7	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0564	061	0	1	01	01	H0564_061_0	7	Select Care Drugs	4	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0564	061	0	1	01	01	H0564_061_0	7	Select Care Drugs	4	001000	1	2	6	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		
H0564	062	0	1	01	01	H0564_062_0	8	Preferred Generic	4	001000	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												
H0564	062	0	1	01	01	H0564_062_0	8	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					12.00	24.00	36.00					12.00	36.00	36.00																17.00				17.00			0.57	0.40	0.40			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0564	062	0	1	01	01	H0564_062_0	8	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	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												
H0564	062	0	1	01	01	H0564_062_0	8	Non-Preferred Drug	4	100100	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												
H0564	062	0	1	01	01	H0564_062_0	8	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0564	062	0	1	01	01	H0564_062_0	8	Select Care Drugs	4	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0564	062	0	1	01	01	H0564_062_0	8	Select Care Drugs	4	001000	1	2	6	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		
H0564	063	0	1	01	01	H0564_063_0	8	Preferred Generic	4	001000	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												
H0564	063	0	1	01	01	H0564_063_0	8	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					12.00	24.00	36.00					12.00	36.00	36.00																17.00				17.00			0.57	0.40	0.40			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0564	063	0	1	01	01	H0564_063_0	8	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	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												
H0564	063	0	1	01	01	H0564_063_0	8	Non-Preferred Drug	4	100100	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												
H0564	063	0	1	01	01	H0564_063_0	8	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0564	063	0	1	01	01	H0564_063_0	8	Select Care Drugs	4	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0564	063	0	1	01	01	H0564_063_0	8	Select Care Drugs	4	001000	1	2	6	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		
H0564	067	1	1	01	01	H0564_067_1	9	Preferred Generic	4	001000	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												
H0564	067	1	1	01	01	H0564_067_1	9	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	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												
H0564	067	1	1	01	01	H0564_067_1	9	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	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												
H0564	067	1	1	01	01	H0564_067_1	9	Non-Preferred Drug	4	100100	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												
H0564	067	1	1	01	01	H0564_067_1	9	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0564	067	1	1	01	01	H0564_067_1	9	Select Care Drugs	4	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0564	067	1	1	01	01	H0564_067_1	9	Select Care Drugs	4	001000	1	2	6	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		
H0564	067	2	1	01	01	H0564_067_2	10	Preferred Generic	4	001000	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												
H0564	067	2	1	01	01	H0564_067_2	10	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	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												
H0564	067	2	1	01	01	H0564_067_2	10	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	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												
H0564	067	2	1	01	01	H0564_067_2	10	Non-Preferred Drug	4	100100	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												
H0564	067	2	1	01	01	H0564_067_2	10	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0564	067	2	1	01	01	H0564_067_2	10	Select Care Drugs	4	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0564	067	2	1	01	01	H0564_067_2	10	Select Care Drugs	4	001000	1	2	6	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		
H0564	068	0	1	01	01	H0564_068_0	8	Preferred Generic	4	001000	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												
H0564	068	0	1	01	01	H0564_068_0	8	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	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												
H0564	068	0	1	01	01	H0564_068_0	8	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	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												
H0564	068	0	1	01	01	H0564_068_0	8	Non-Preferred Drug	4	100100	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												
H0564	068	0	1	01	01	H0564_068_0	8	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0564	068	0	1	01	01	H0564_068_0	8	Select Care Drugs	4	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0564	068	0	1	01	01	H0564_068_0	8	Select Care Drugs	4	001000	1	2	6	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		
H0564	069	0	1	01	01	H0564_069_0	7	Preferred Generic	4	001000	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												
H0564	069	0	1	01	01	H0564_069_0	7	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					12.00	24.00	36.00					12.00	36.00	36.00																17.00				17.00			0.57	0.40	0.40			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0564	069	0	1	01	01	H0564_069_0	7	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	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												
H0564	069	0	1	01	01	H0564_069_0	7	Non-Preferred Drug	4	100100	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												
H0564	069	0	1	01	01	H0564_069_0	7	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0564	069	0	1	01	01	H0564_069_0	7	Select Care Drugs	4	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0564	069	0	1	01	01	H0564_069_0	7	Select Care Drugs	4	001000	1	2	6	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		
H0564	070	0	1	01	01	H0564_070_0	7	Preferred Generic	4	001000	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												
H0564	070	0	1	01	01	H0564_070_0	7	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					12.00	24.00	36.00					12.00	36.00	36.00																17.00				17.00			0.57	0.40	0.40			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0564	070	0	1	01	01	H0564_070_0	7	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	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												
H0564	070	0	1	01	01	H0564_070_0	7	Non-Preferred Drug	4	100100	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												
H0564	070	0	1	01	01	H0564_070_0	7	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0564	070	0	1	01	01	H0564_070_0	7	Select Care Drugs	4	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0564	070	0	1	01	01	H0564_070_0	7	Select Care Drugs	4	001000	1	2	6	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		
H0564	071	0	1	01	01	H0564_071_0	7	Preferred Generic	4	001000	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												
H0564	071	0	1	01	01	H0564_071_0	7	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0564	071	0	1	01	01	H0564_071_0	7	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	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												
H0564	071	0	1	01	01	H0564_071_0	7	Non-Preferred Drug	4	100100	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												
H0564	071	0	1	01	01	H0564_071_0	7	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0564	071	0	1	01	01	H0564_071_0	7	Select Care Drugs	4	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0564	071	0	1	01	01	H0564_071_0	7	Select Care Drugs	4	001000	1	2	6	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		
H0564	072	0	1	01	01	H0564_072_0	8	Preferred Generic	4	001000	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												
H0564	072	0	1	01	01	H0564_072_0	8	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0564	072	0	1	01	01	H0564_072_0	8	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	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												
H0564	072	0	1	01	01	H0564_072_0	8	Non-Preferred Drug	4	100100	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												
H0564	072	0	1	01	01	H0564_072_0	8	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0564	072	0	1	01	01	H0564_072_0	8	Select Care Drugs	4	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0564	072	0	1	01	01	H0564_072_0	8	Select Care Drugs	4	001000	1	2	6	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		
H0564	074	0	1	01	01	H0564_074_0	7	Preferred Generic	4	001000	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												
H0564	074	0	1	01	01	H0564_074_0	7	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0564	074	0	1	01	01	H0564_074_0	7	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	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												
H0564	074	0	1	01	01	H0564_074_0	7	Non-Preferred Drug	4	100100	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												
H0564	074	0	1	01	01	H0564_074_0	7	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0564	074	0	1	01	01	H0564_074_0	7	Select Care Drugs	4	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0564	074	0	1	01	01	H0564_074_0	7	Select Care Drugs	4	001000	1	2	6	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		
H0564	076	0	1	01	01	H0564_076_0	9	Preferred Generic	4	001000	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												
H0564	076	0	1	01	01	H0564_076_0	9	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0564	076	0	1	01	01	H0564_076_0	9	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	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												
H0564	076	0	1	01	01	H0564_076_0	9	Non-Preferred Drug	4	100100	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												
H0564	076	0	1	01	01	H0564_076_0	9	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0564	076	0	1	01	01	H0564_076_0	9	Select Care Drugs	4	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0564	076	0	1	01	01	H0564_076_0	9	Select Care Drugs	4	001000	1	2	6	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		
H0564	077	0	1	01	01	H0564_077_0	9	Preferred Generic	4	001000	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												
H0564	077	0	1	01	01	H0564_077_0	9	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0564	077	0	1	01	01	H0564_077_0	9	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	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												
H0564	077	0	1	01	01	H0564_077_0	9	Non-Preferred Drug	4	100100	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												
H0564	077	0	1	01	01	H0564_077_0	9	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0564	077	0	1	01	01	H0564_077_0	9	Select Care Drugs	4	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0564	077	0	1	01	01	H0564_077_0	9	Select Care Drugs	4	001000	1	2	6	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		
H0564	078	0	1	01	01	H0564_078_0	8	Preferred Generic	4	001000	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												
H0564	078	0	1	01	01	H0564_078_0	8	Generic	4	010000	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												
H0564	078	0	1	01	01	H0564_078_0	8	Preferred Brand	4	000101	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												
H0564	078	0	1	01	01	H0564_078_0	8	Non-Preferred Drug	4	100100	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												
H0564	078	0	1	01	01	H0564_078_0	8	Specialty Tier	4	010010	1	1	5	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												
H0564	078	0	1	01	01	H0564_078_0	8	Select Care Drugs	4	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0564	078	0	1	01	01	H0564_078_0	8	Select Care Drugs	4	001000	1	2	6	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		
H0564	079	0	1	01	01	H0564_079_0	9	Preferred Generic	4	001000	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												
H0564	079	0	1	01	01	H0564_079_0	9	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								7.00	14.00	21.00					7.00	14.00	21.00					7.00	21.00	21.00																7.00				7.00			0.23	0.23	0.23			0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0564	079	0	1	01	01	H0564_079_0	9	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								45.00	90.00	135.00					45.00	90.00	135.00					45.00	135.00	135.00																45.00				45.00			1.50	1.50	1.50			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0564	079	0	1	01	01	H0564_079_0	9	Non-Preferred Drug	4	100100	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								97.00	194.00	291.00					92.00	184.00	276.00					92.00	276.00	276.00																97.00				97.00			3.23	3.07	3.07			2.85	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0564	079	0	1	01	01	H0564_079_0	9	Specialty Tier	4	010010	1	1	5	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												
H0564	079	0	1	01	01	H0564_079_0	9	Select Care Drugs	4	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0564	079	0	1	01	01	H0564_079_0	9	Select Care Drugs	4	001000	1	2	6	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		
H0564	080	0	1	01	01	H0564_080_0	8	Preferred Generic	4	001000	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												
H0564	080	0	1	01	01	H0564_080_0	8	Generic	4	010000	1	2	2	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												
H0564	080	0	1	01	01	H0564_080_0	8	Preferred Brand	4	000101	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												
H0564	080	0	1	01	01	H0564_080_0	8	Non-Preferred Drug	4	100100	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								97.00	194.00	291.00					92.00	184.00	276.00					92.00	276.00	276.00																97.00				97.00			3.23	3.07	3.07			2.85	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0564	080	0	1	01	01	H0564_080_0	8	Specialty Tier	4	010010	1	1	5	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												
H0564	080	0	1	01	01	H0564_080_0	8	Select Care Drugs	4	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H0564	080	0	1	01	01	H0564_080_0	8	Select Care Drugs	4	001000	1	2	6	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		
H0571	001	0	1	01	01	H0571_001_0	6	Preferred Generic	4	001000	1	2	1	1		111	10	100		1				30	60	90	1	2			90					14	31								3.00	6.00	9.00					3.00	6.00	6.00							6.00																	3.00			3.00			0.10	0.10				0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0571	001	0	1	01	01	H0571_001_0	6	Generic	4	010000	1	2	2	1		111	10	100		1				30	60	90	1	2			90					14	31								7.00	14.00	21.00					7.00	14.00	14.00							14.00																	7.00			7.00			0.23	0.23				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0571	001	0	1	01	01	H0571_001_0	6	Preferred Brand	4	000001	1	2	3	1		111	10	100		1				30	60	90	1	2			90					14	31								40.00	80.00	120.00					40.00	80.00	80.00							80.00																	40.00			40.00			1.33	1.33				1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0571	001	0	1	01	01	H0571_001_0	6	Non-Preferred Brand	4	110000	1	2	4	1		111	10	100		1				30	60	90	1	2			90					14	31								60.00	120.00	180.00					60.00	120.00	120.00							120.00																	60.00			60.00			2.00	2.00				1.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0571	001	0	1	01	01	H0571_001_0	6	Specialty Tier	4	010010	1	1	5	1		010	10	010		1				30					30							14	31												25							25						25																		25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0602	017	0	1	18	06	H0602_017_0	8	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	3.00		9.00																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0602	017	0	1	18	06	H0602_017_0	8	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	20.00		60.00																					60.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0602	017	0	1	18	06	H0602_017_0	8	Preferred Brand	4	000001	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												
H0602	017	0	1	18	06	H0602_017_0	8	Non-Preferred Brand	4	100000	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	90.00		270.00																					270.00																90.00				90.00		3.00						2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0602	017	0	1	18	06	H0602_017_0	8	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31				1062.26	28																				28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0602	019	0	1	18	06	H0602_019_0	9	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	3.00		9.00																					9.00																3.00				3.00		0.10						.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0602	019	0	1	18	06	H0602_019_0	9	Preferred Generic	4	001000	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	3.00		9.00																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0602	019	0	1	18	06	H0602_019_0	9	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	20.00		60.00																					60.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0602	019	0	1	18	06	H0602_019_0	9	Generic	4	010000	1	2	2	3	110		01	100		1	30		90				1	2			90				30		31	20.00		60.00																					60.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H0602	019	0	1	18	06	H0602_019_0	9	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	40.00		120.00																					120.00																40.00				40.00		1.33						1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0602	019	0	1	18	06	H0602_019_0	9	Non-Preferred Brand	4	100000	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	90.00		270.00																					270.00																90.00				90.00		3.00						2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0602	019	0	1	18	06	H0602_019_0	9	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31				2238.26	31																				31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0602	020	0	1	18	06	H0602_020_0	9	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	3.00		9.00																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0602	020	0	1	18	06	H0602_020_0	9	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	20.00		60.00																					60.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0602	020	0	1	18	06	H0602_020_0	9	Preferred Brand	4	000001	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												
H0602	020	0	1	18	06	H0602_020_0	9	Non-Preferred Brand	4	100000	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	90.00		270.00																					270.00																90.00				90.00		3.00						2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0602	020	0	1	18	06	H0602_020_0	9	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31				972.53	28																				28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0602	022	0	1	18	06	H0602_022_0	9	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	3.00		9.00																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0602	022	0	1	18	06	H0602_022_0	9	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	20.00		60.00																					60.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0602	022	0	1	18	06	H0602_022_0	9	Preferred Brand	4	000001	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												
H0602	022	0	1	18	06	H0602_022_0	9	Non-Preferred Brand	4	100000	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	90.00		270.00																					270.00																90.00				90.00		3.00						2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0602	022	0	1	18	06	H0602_022_0	9	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31				1124.19	28																				28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0602	039	0	1	18	06	H0602_039_0	10	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	3.00		9.00																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0602	039	0	1	18	06	H0602_039_0	10	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	20.00		60.00																					60.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0602	039	0	1	18	06	H0602_039_0	10	Preferred Brand	4	000001	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												
H0602	039	0	1	18	06	H0602_039_0	10	Non-Preferred Brand	4	100000	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	90.00		270.00																					270.00																90.00				90.00		3.00						2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0602	039	0	1	18	06	H0602_039_0	10	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31				496.09	26																				26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0602	043	0	1	18	06	H0602_043_0	9	Preferred Generic	3	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	7.00		21.00																					21.00																7.00				7.00		0.23						0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0602	043	0	1	18	06	H0602_043_0	9	Generic	3	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	20.00		60.00																					60.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0602	043	0	1	18	06	H0602_043_0	9	Preferred Brand	3	000001	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												
H0602	043	0	1	18	06	H0602_043_0	9	Non-Preferred Brand	3	100000	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	90.00		270.00																					270.00																90.00				90.00		3.00						2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0602	043	0	1	18	06	H0602_043_0	9	Specialty Tier	3	010010	1	1	5	1	010		01	010		1	30								30						30		31				767.30	26																				26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H0609	002	0	1	01	01	H0609_002_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	002	0	1	01	01	H0609_002_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	002	0	1	01	01	H0609_002_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		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	002	0	1	01	01	H0609_002_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	002	0	1	01	01	H0609_002_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				584.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	007	0	1	01	01	H0609_007_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	007	0	1	01	01	H0609_007_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	007	0	1	01	01	H0609_007_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		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	007	0	1	01	01	H0609_007_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	007	0	1	01	01	H0609_007_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				667.00	30		30																										30						30			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	012	0	1	01	01	H0609_012_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	012	0	1	01	01	H0609_012_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	012	0	1	01	01	H0609_012_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		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	012	0	1	01	01	H0609_012_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	012	0	1	01	01	H0609_012_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				663.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	020	0	1	01	01	H0609_020_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	020	0	1	01	01	H0609_020_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	020	0	1	01	01	H0609_020_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		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	020	0	1	01	01	H0609_020_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	020	0	1	01	01	H0609_020_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				666.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	025	0	1	01	01	H0609_025_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	025	0	1	01	01	H0609_025_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	025	0	1	01	01	H0609_025_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	025	0	1	01	01	H0609_025_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	025	0	1	01	01	H0609_025_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				878.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	026	0	1	01	01	H0609_026_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	026	0	1	01	01	H0609_026_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	026	0	1	01	01	H0609_026_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	026	0	1	01	01	H0609_026_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	026	0	1	01	01	H0609_026_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				724.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	027	0	1	01	01	H0609_027_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	027	0	1	01	01	H0609_027_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	027	0	1	01	01	H0609_027_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	027	0	1	01	01	H0609_027_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	027	0	1	01	01	H0609_027_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				797.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	028	0	1	01	01	H0609_028_0	6	Preferred Generic	4	001000	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	028	0	1	01	01	H0609_028_0	6	Preferred Generic	4	001000	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0609	028	0	1	01	01	H0609_028_0	6	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	028	0	1	01	01	H0609_028_0	6	Generic	4	010000	1	2	2	3	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H0609	028	0	1	01	01	H0609_028_0	6	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	028	0	1	01	01	H0609_028_0	6	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0609	028	0	1	01	01	H0609_028_0	6	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				1007.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0630	013	0	1	01	01	H0630_013_0	10	Preferred Generic	4	001000	1	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	7.00		21.00																			7.00		14.00																7.00				7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	013	0	1	01	01	H0630_013_0	10	Preferred Generic	4	001000	1	2	1	3	110		01	110		1	30		90				2	2	30		90				30		31	7.00		21.00																			7.00		14.00																7.00				7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0630	013	0	1	01	01	H0630_013_0	10	Generic	4	010000	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	18.00		54.00																			18.00		36.00																18.00				18.00		0.60			0.60			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	013	0	1	01	01	H0630_013_0	10	Generic	4	010000	1	2	2	3	110		01	110		1	30		90				2	2	30		90				30		31	18.00		54.00																			18.00		36.00																18.00				18.00		0.60			0.60			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0630	013	0	1	01	01	H0630_013_0	10	Preferred Brand	4	000001	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 Brand, Specialty Tier, Vaccines												
H0630	013	0	1	01	01	H0630_013_0	10	Non-Preferred Brand	4	100000	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 Brand, Specialty Tier, Vaccines												
H0630	013	0	1	01	01	H0630_013_0	10	Specialty Tier	4	010010	1	1	5	1	110		01	110		1	30		90				2	2	30		90				30		31				1860.00	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	10	Vaccines	4	000001	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	013	0	1	01	01	H0630_013_0	10	Vaccines	4	000001	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0630	015	0	1	01	01	H0630_015_0	12	Preferred Generic	4	001000	1	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	6.00		18.00																			6.00		12.00																6.00				6.00		0.20			0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	015	0	1	01	01	H0630_015_0	12	Preferred Generic	4	001000	1	2	1	3	110		01	110		1	30		90				2	2	30		90				30		31	6.00		18.00																			6.00		12.00																6.00				6.00		0.20			0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0630	015	0	1	01	01	H0630_015_0	12	Generic	4	010000	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 Brand, Specialty Tier, Vaccines												
H0630	015	0	1	01	01	H0630_015_0	12	Generic	4	010000	1	2	2	3	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 Brand, Specialty Tier, Vaccines										1		
H0630	015	0	1	01	01	H0630_015_0	12	Preferred Brand	4	000001	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 Brand, Specialty Tier, Vaccines												
H0630	015	0	1	01	01	H0630_015_0	12	Non-Preferred Brand	4	100000	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 Brand, Specialty Tier, Vaccines												
H0630	015	0	1	01	01	H0630_015_0	12	Specialty Tier	4	010010	1	1	5	1	110		01	110		1	30		90				2	2	30		90				30		31				1724.00	33		33																		33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	015	0	1	01	01	H0630_015_0	12	Vaccines	4	000001	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	015	0	1	01	01	H0630_015_0	12	Vaccines	4	000001	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0630	016	0	1	01	01	H0630_016_0	12	Preferred Generic	4	001000	1	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	4.00		12.00																			4.00		8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	016	0	1	01	01	H0630_016_0	12	Preferred Generic	4	001000	1	2	1	3	110		01	110		1	30		90				2	2	30		90				30		31	4.00		12.00																			4.00		8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0630	016	0	1	01	01	H0630_016_0	12	Generic	4	010000	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 Brand, Specialty Tier, Vaccines												
H0630	016	0	1	01	01	H0630_016_0	12	Generic	4	010000	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 Brand, Specialty Tier, Vaccines										1		
H0630	016	0	1	01	01	H0630_016_0	12	Preferred Brand	4	000001	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 Brand, Specialty Tier, Vaccines												
H0630	016	0	1	01	01	H0630_016_0	12	Non-Preferred Brand	4	100000	1	2	4	1	110		01	110		1	30		90				2	2	30		90				30		31	95.00		285.00																			95.00		190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	016	0	1	01	01	H0630_016_0	12	Specialty Tier	4	010010	1	1	5	1	110		01	110		1	30		90				2	2	30		90				30		31				1705.00	33		33																		33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	016	0	1	01	01	H0630_016_0	12	Vaccines	4	000001	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	016	0	1	01	01	H0630_016_0	12	Vaccines	4	000001	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0630	017	0	1	01	01	H0630_017_0	12	Preferred Generic	4	001000	1	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	7.00		21.00																			7.00		14.00																7.00				7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	017	0	1	01	01	H0630_017_0	12	Preferred Generic	4	001000	1	2	1	3	110		01	110		1	30		90				2	2	30		90				30		31	7.00		21.00																			7.00		14.00																7.00				7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0630	017	0	1	01	01	H0630_017_0	12	Generic	4	010000	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	18.00		54.00																			18.00		36.00																18.00				18.00		0.60			0.60			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	017	0	1	01	01	H0630_017_0	12	Generic	4	010000	1	2	2	3	110		01	110		1	30		90				2	2	30		90				30		31	18.00		54.00																			18.00		36.00																18.00				18.00		0.60			0.60			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0630	017	0	1	01	01	H0630_017_0	12	Preferred Brand	4	000001	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 Brand, Specialty Tier, Vaccines												
H0630	017	0	1	01	01	H0630_017_0	12	Non-Preferred Brand	4	100000	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 Brand, Specialty Tier, Vaccines												
H0630	017	0	1	01	01	H0630_017_0	12	Specialty Tier	4	010010	1	1	5	1	110		01	110		1	30		90				2	2	30		90				30		31				1979.00	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	12	Vaccines	4	000001	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	017	0	1	01	01	H0630_017_0	12	Vaccines	4	000001	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0630	018	0	1	01	01	H0630_018_0	12	Preferred Generic	4	001000	1	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	6.00		18.00																			6.00		12.00																6.00				6.00		0.20			0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	018	0	1	01	01	H0630_018_0	12	Preferred Generic	4	001000	1	2	1	3	110		01	110		1	30		90				2	2	30		90				30		31	6.00		18.00																			6.00		12.00																6.00				6.00		0.20			0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0630	018	0	1	01	01	H0630_018_0	12	Generic	4	010000	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 Brand, Specialty Tier, Vaccines												
H0630	018	0	1	01	01	H0630_018_0	12	Generic	4	010000	1	2	2	3	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 Brand, Specialty Tier, Vaccines										1		
H0630	018	0	1	01	01	H0630_018_0	12	Preferred Brand	4	000001	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 Brand, Specialty Tier, Vaccines												
H0630	018	0	1	01	01	H0630_018_0	12	Non-Preferred Brand	4	100000	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 Brand, Specialty Tier, Vaccines												
H0630	018	0	1	01	01	H0630_018_0	12	Specialty Tier	4	010010	1	1	5	1	110		01	110		1	30		90				2	2	30		90				30		31				1714.00	33		33																		33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	018	0	1	01	01	H0630_018_0	12	Vaccines	4	000001	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	018	0	1	01	01	H0630_018_0	12	Vaccines	4	000001	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0630	020	0	1	01	01	H0630_020_0	12	Preferred Generic	4	001000	1	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	7.00		21.00																			7.00		14.00																7.00				7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	020	0	1	01	01	H0630_020_0	12	Preferred Generic	4	001000	1	2	1	3	110		01	110		1	30		90				2	2	30		90				30		31	7.00		21.00																			7.00		14.00																7.00				7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0630	020	0	1	01	01	H0630_020_0	12	Generic	4	010000	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	18.00		54.00																			18.00		36.00																18.00				18.00		0.60			0.60			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	020	0	1	01	01	H0630_020_0	12	Generic	4	010000	1	2	2	3	110		01	110		1	30		90				2	2	30		90				30		31	18.00		54.00																			18.00		36.00																18.00				18.00		0.60			0.60			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0630	020	0	1	01	01	H0630_020_0	12	Preferred Brand	4	000001	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 Brand, Specialty Tier, Vaccines												
H0630	020	0	1	01	01	H0630_020_0	12	Non-Preferred Brand	4	100000	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 Brand, Specialty Tier, Vaccines												
H0630	020	0	1	01	01	H0630_020_0	12	Specialty Tier	4	010010	1	1	5	1	110		01	110		1	30		90				2	2	30		90				30		31				2367.00	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	12	Vaccines	4	000001	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	020	0	1	01	01	H0630_020_0	12	Vaccines	4	000001	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0630	021	0	1	01	01	H0630_021_0	13	Preferred Generic	4	001000	1	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	6.00		18.00																			6.00		12.00																6.00				6.00		0.20			0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	021	0	1	01	01	H0630_021_0	13	Preferred Generic	4	001000	1	2	1	3	110		01	110		1	30		90				2	2	30		90				30		31	6.00		18.00																			6.00		12.00																6.00				6.00		0.20			0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0630	021	0	1	01	01	H0630_021_0	13	Generic	4	010000	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 Brand, Specialty Tier, Vaccines												
H0630	021	0	1	01	01	H0630_021_0	13	Generic	4	010000	1	2	2	3	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 Brand, Specialty Tier, Vaccines										1		
H0630	021	0	1	01	01	H0630_021_0	13	Preferred Brand	4	000001	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 Brand, Specialty Tier, Vaccines												
H0630	021	0	1	01	01	H0630_021_0	13	Non-Preferred Brand	4	100000	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 Brand, Specialty Tier, Vaccines												
H0630	021	0	1	01	01	H0630_021_0	13	Specialty Tier	4	010010	1	1	5	1	110		01	110		1	30		90				2	2	30		90				30		31				3120.00	33		33																		33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	021	0	1	01	01	H0630_021_0	13	Vaccines	4	000001	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H0630	021	0	1	01	01	H0630_021_0	13	Vaccines	4	000001	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H0710	006	0	1	04	01	H0710_006_0	7	Preferred Generic	3	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	006	0	1	04	01	H0710_006_0	7	Generic	3	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		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	006	0	1	04	01	H0710_006_0	7	Preferred Brand	3	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		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	006	0	1	04	01	H0710_006_0	7	Non-Preferred Drug	3	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		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	006	0	1	04	01	H0710_006_0	7	Specialty Tier	3	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				539.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	008	0	1	04	01	H0710_008_0	7	Preferred Generic	3	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	008	0	1	04	01	H0710_008_0	7	Generic	3	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		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	7	Preferred Brand	3	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		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	7	Non-Preferred Drug	3	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		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	7	Specialty Tier	3	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				539.00	30		30																										30						30			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	009	0	1	04	01	H0710_009_0	7	Preferred Generic	3	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	009	0	1	04	01	H0710_009_0	7	Generic	3	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		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	7	Preferred Brand	3	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		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	7	Non-Preferred Drug	3	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		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	7	Specialty Tier	3	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				539.00	30		30																										30						30			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	012	0	1	04	01	H0710_012_0	7	Preferred Generic	3	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	012	0	1	04	01	H0710_012_0	7	Generic	3	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		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	7	Preferred Brand	3	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		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	7	Non-Preferred Drug	3	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		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	7	Specialty Tier	3	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				539.00	30		30																										30						30			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	018	0	1	04	01	H0710_018_0	7	Preferred Generic	3	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	018	0	1	04	01	H0710_018_0	7	Generic	3	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		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	018	0	1	04	01	H0710_018_0	7	Preferred Brand	3	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		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	018	0	1	04	01	H0710_018_0	7	Non-Preferred Drug	3	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		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	018	0	1	04	01	H0710_018_0	7	Specialty Tier	3	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				795.00	32		32																										32						32			32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	030	0	1	04	01	H0710_030_0	7	Preferred Generic	3	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0710	030	0	1	04	01	H0710_030_0	7	Generic	3	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		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	7	Preferred Brand	3	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		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	7	Non-Preferred Drug	3	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		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	7	Specialty Tier	3	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				786.00	31		31																										31						31			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0712	005	0	1	01	01	H0712_005_0	5	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0712	005	0	1	01	01	H0712_005_0	5	Generic	4	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		50.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0712	005	0	1	01	01	H0712_005_0	5	Preferred Brand	4	000101	1	2	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												
H0712	005	0	1	01	01	H0712_005_0	5	Non-Preferred Drug	4	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				99.28	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0712	005	0	1	01	01	H0712_005_0	5	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				2221.46	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0712	019	0	1	01	01	H0712_019_0	5	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0712	019	0	1	01	01	H0712_019_0	5	Generic	4	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		37.50				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0712	019	0	1	01	01	H0712_019_0	5	Preferred Brand	4	000101	1	2	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												
H0712	019	0	1	01	01	H0712_019_0	5	Non-Preferred Drug	4	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				90.70	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0712	019	0	1	01	01	H0712_019_0	5	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				2238.31	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0712	020	0	1	01	01	H0712_020_0	8	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	2.00		6.00																									2.00		6.00				2.00		0.00				2.00				2.00		0.07				0.07	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0712	020	0	1	01	01	H0712_020_0	8	Generic	4	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	11.00		33.00																									11.00		33.00				11.00		27.50				11.00				11.00		0.37				0.37	0.37	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0712	020	0	1	01	01	H0712_020_0	8	Preferred Brand	4	000101	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	46.00		138.00																									46.00		138.00				46.00		115.00				46.00				46.00		1.53				1.53	1.53	1.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0712	020	0	1	01	01	H0712_020_0	8	Non-Preferred Drug	4	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				84.87	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0712	020	0	1	01	01	H0712_020_0	8	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				2252.03	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0735	001	0	1	04	01	H0735_001_0	11	Preferred Generic	4	001000	1	2	1	1	110		10	110		1	30		90				1	2	30		90					29	31	6.00		18.00																			6.00		12.00																	6.00			6.00		0.20			0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0735	001	0	1	04	01	H0735_001_0	11	Generic	4	010000	1	2	2	1	110		10	110		1	30		90				1	2	30		90					29	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												
H0735	001	0	1	04	01	H0735_001_0	11	Preferred Brand	4	000001	1	2	3	1	110		10	110		1	30		90				1	2	30		90					29	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												
H0735	001	0	1	04	01	H0735_001_0	11	Non-Preferred Drug	4	100100	1	2	4	1	110		10	110		1	30		90				1	2	30		90					29	31	90.00		270.00																			90.00		180.00																	90.00			90.00		3.00			3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0735	001	0	1	04	01	H0735_001_0	11	Specialty Tier	4	010010	1	1	5	1	110		10	110		1	30		90				1	2	30		90					29	31				624.14	29		29																		29		29																29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0735	002	0	1	04	01	H0735_002_0	8	Preferred Generic	4	001000	1	2	1	1	110		10	110		1	30		90				1	2	30		90					29	31	6.00		18.00																			6.00		12.00																	6.00			6.00		0.20			0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0735	002	0	1	04	01	H0735_002_0	8	Generic	4	010000	1	2	2	1	110		10	110		1	30		90				1	2	30		90					29	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												
H0735	002	0	1	04	01	H0735_002_0	8	Preferred Brand	4	000001	1	2	3	1	110		10	110		1	30		90				1	2	30		90					29	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												
H0735	002	0	1	04	01	H0735_002_0	8	Non-Preferred Drug	4	100100	1	2	4	1	110		10	110		1	30		90				1	2	30		90					29	31	80.00		240.00																			80.00		160.00																	80.00			80.00		2.67			2.67			2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0735	002	0	1	04	01	H0735_002_0	8	Specialty Tier	4	010010	1	1	5	1	110		10	110		1	30		90				1	2	30		90					29	31				798.57	30		30																		30		30																30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	030	0	1	01	01	H0755_030_0	5	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	030	0	1	01	01	H0755_030_0	5	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	030	0	1	01	01	H0755_030_0	5	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	030	0	1	01	01	H0755_030_0	5	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	030	0	1	01	01	H0755_030_0	5	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				539.00	31		31																										31						31			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	031	0	1	01	01	H0755_031_0	5	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	031	0	1	01	01	H0755_031_0	5	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	9.00		27.00																											27.00						0.00				9.00				9.00		0.30						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	031	0	1	01	01	H0755_031_0	5	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	031	0	1	01	01	H0755_031_0	5	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	031	0	1	01	01	H0755_031_0	5	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				539.00	30		30																										30						30			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	033	0	1	01	01	H0755_033_0	5	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	033	0	1	01	01	H0755_033_0	5	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		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	033	0	1	01	01	H0755_033_0	5	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	033	0	1	01	01	H0755_033_0	5	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	033	0	1	01	01	H0755_033_0	5	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				539.00	30		30																										30						30			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	034	0	1	01	01	H0755_034_0	5	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	034	0	1	01	01	H0755_034_0	5	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		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	034	0	1	01	01	H0755_034_0	5	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	034	0	1	01	01	H0755_034_0	5	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	034	0	1	01	01	H0755_034_0	5	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				737.00	27		27																										27						27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	035	0	1	01	01	H0755_035_0	5	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	035	0	1	01	01	H0755_035_0	5	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	035	0	1	01	01	H0755_035_0	5	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		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	035	0	1	01	01	H0755_035_0	5	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	035	0	1	01	01	H0755_035_0	5	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				789.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	036	0	1	01	01	H0755_036_0	5	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	036	0	1	01	01	H0755_036_0	5	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	036	0	1	01	01	H0755_036_0	5	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		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	036	0	1	01	01	H0755_036_0	5	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	036	0	1	01	01	H0755_036_0	5	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				879.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	038	0	1	01	01	H0755_038_0	5	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	038	0	1	01	01	H0755_038_0	5	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	038	0	1	01	01	H0755_038_0	5	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	038	0	1	01	01	H0755_038_0	5	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0755	038	0	1	01	01	H0755_038_0	5	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				804.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0811	001	0	1	49	05	H0811_001_0	9	Generic Drugs	4	010000			1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31																																														0.00			0.00			0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0811	001	0	1	49	05	H0811_001_0	9	Brand Drugs	4	000010			2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31																																														0.00			0.00			0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0811	001	0	1	49	05	H0811_001_0	9	Non-Medicare Rx Drugs	4	010010			3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31																																														0.00			0.00			0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0811	001	0	1	49	05	H0811_001_0	9	Non-Medicare OTC Drugs	4	010010			4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31																																														0.00			0.00			0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0838	020	0	1	01	01	H0838_020_0	11	Preferred Generic	4	001000	1	1	1	1	110		01	100		1	30		90				1	2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	020	0	1	01	01	H0838_020_0	11	Generic	4	010000	1	1	2	1	110		01	100		1	30		90				1	2			90				30		31				11.73	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	020	0	1	01	01	H0838_020_0	11	Preferred Brand	4	000001	1	1	3	1	110		01	100		1	30		90				1	2			90				30		31				66.16	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	020	0	1	01	01	H0838_020_0	11	Non-Preferred Brand	4	100000	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				127.86	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	020	0	1	01	01	H0838_020_0	11	Specialty Tier	4	100000	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 Diabetic Drugs												
H0838	020	0	1	01	01	H0838_020_0	11	Select Diabetic Drugs	4	000001	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	11.00		33.00																					22.00																11.00				11.00		0.37						0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	024	0	1	01	01	H0838_024_0	10	Preferred Generic	4	001000	1	1	1	1	110		01	100		1	30		90				1	2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	024	0	1	01	01	H0838_024_0	10	Generic	4	010000	1	1	2	1	110		01	100		1	30		90				1	2			90				30		31				7.52	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	024	0	1	01	01	H0838_024_0	10	Preferred Brand	4	000001	1	1	3	1	110		01	100		1	30		90				1	2			90				30		31				75.76	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	024	0	1	01	01	H0838_024_0	10	Non-Preferred Brand	4	100000	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				123.04	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	024	0	1	01	01	H0838_024_0	10	Specialty Tier	4	100000	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 Diabetic Drugs												
H0838	024	0	1	01	01	H0838_024_0	10	Select Diabetic Drugs	4	000001	1	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, Select Diabetic Drugs												
H0838	025	0	1	01	01	H0838_025_0	12	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	025	0	1	01	01	H0838_025_0	12	Preferred Generic	4	001000	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs										1		
H0838	025	0	1	01	01	H0838_025_0	12	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	5.00		15.00																					10.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	025	0	1	01	01	H0838_025_0	12	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	45.00		135.00																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	025	0	1	01	01	H0838_025_0	12	Non-Preferred Brand	4	100000	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	90.00		270.00																					180.00																90.00				90.00		3.00						2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	025	0	1	01	01	H0838_025_0	12	Specialty Tier	4	100000	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 Diabetic Drugs												
H0838	025	0	1	01	01	H0838_025_0	12	Select Diabetic Drugs	4	000001	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	11.00		33.00																					22.00																11.00				11.00		0.37						0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	026	0	1	01	01	H0838_026_0	10	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	026	0	1	01	01	H0838_026_0	10	Preferred Generic	4	001000	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs										1		
H0838	026	0	1	01	01	H0838_026_0	10	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	9.00		27.00																					18.00																9.00				9.00		0.30						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	026	0	1	01	01	H0838_026_0	10	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	45.00		135.00																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	026	0	1	01	01	H0838_026_0	10	Non-Preferred Brand	4	100000	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	95.00		285.00																					190.00																95.00				95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	026	0	1	01	01	H0838_026_0	10	Specialty Tier	4	100000	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 Diabetic Drugs												
H0838	026	0	1	01	01	H0838_026_0	10	Select Diabetic Drugs	4	000001	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	11.00		33.00																					22.00																11.00				11.00		0.37						0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	026	0	1	01	01	H0838_026_0	10	Select Diabetic Drugs	4	000001	1	2	6	3	110		01	100		1	30		90				1	2			90				30		31	11.00		33.00																					22.00																11.00				11.00		0.37						0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs										1		
H0838	027	0	1	01	01	H0838_027_0	10	Preferred Generic	4	001000	1	1	1	1	110		01	100		1	30		90				1	2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	027	0	1	01	01	H0838_027_0	10	Generic	4	010000	1	1	2	1	110		01	100		1	30		90				1	2			90				30		31				6.91	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	027	0	1	01	01	H0838_027_0	10	Preferred Brand	4	000001	1	1	3	1	110		01	100		1	30		90				1	2			90				30		31				66.91	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	027	0	1	01	01	H0838_027_0	10	Non-Preferred Brand	4	100000	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				62.21	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	027	0	1	01	01	H0838_027_0	10	Specialty Tier	4	100000	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 Diabetic Drugs												
H0838	027	0	1	01	01	H0838_027_0	10	Select Diabetic Drugs	4	000001	1	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, Select Diabetic Drugs												
H0838	028	0	1	01	01	H0838_028_0	11	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	028	0	1	01	01	H0838_028_0	11	Preferred Generic	4	001000	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs										1		
H0838	028	0	1	01	01	H0838_028_0	11	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	9.00		27.00																					18.00																9.00				9.00		0.30						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	028	0	1	01	01	H0838_028_0	11	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	45.00		135.00																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	028	0	1	01	01	H0838_028_0	11	Non-Preferred Brand	4	100000	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	95.00		285.00																					190.00																95.00				95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	028	0	1	01	01	H0838_028_0	11	Specialty Tier	4	100000	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 Diabetic Drugs												
H0838	028	0	1	01	01	H0838_028_0	11	Select Diabetic Drugs	4	000001	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	11.00		33.00																					22.00																11.00				11.00		0.37						0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	029	0	1	01	01	H0838_029_0	10	Preferred Generic	4	001000	1	1	1	1	110		01	100		1	30		90				1	2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	029	0	1	01	01	H0838_029_0	10	Generic	4	010000	1	1	2	1	110		01	100		1	30		90				1	2			90				30		31				6.19	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	029	0	1	01	01	H0838_029_0	10	Preferred Brand	4	000001	1	1	3	1	110		01	100		1	30		90				1	2			90				30		31				51.73	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	029	0	1	01	01	H0838_029_0	10	Non-Preferred Brand	4	100000	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				55.98	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	029	0	1	01	01	H0838_029_0	10	Specialty Tier	4	100000	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 Diabetic Drugs												
H0838	029	0	1	01	01	H0838_029_0	10	Select Diabetic Drugs	4	000001	1	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, Select Diabetic Drugs												
H0838	030	0	1	01	01	H0838_030_0	10	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	030	0	1	01	01	H0838_030_0	10	Preferred Generic	4	001000	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs										1		
H0838	030	0	1	01	01	H0838_030_0	10	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	9.00		27.00																					18.00																9.00				9.00		0.30						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	030	0	1	01	01	H0838_030_0	10	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	45.00		135.00																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	030	0	1	01	01	H0838_030_0	10	Non-Preferred Brand	4	100000	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	95.00		285.00																					190.00																95.00				95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	030	0	1	01	01	H0838_030_0	10	Specialty Tier	4	100000	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 Diabetic Drugs												
H0838	030	0	1	01	01	H0838_030_0	10	Select Diabetic Drugs	4	000001	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	11.00		33.00																					22.00																11.00				11.00		0.37						0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	031	0	1	01	01	H0838_031_0	10	Preferred Generic	4	001000	1	1	1	1	110		01	100		1	30		90				1	2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	031	0	1	01	01	H0838_031_0	10	Generic	4	010000	1	1	2	1	110		01	100		1	30		90				1	2			90				30		31				6.99	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	031	0	1	01	01	H0838_031_0	10	Preferred Brand	4	000001	1	1	3	1	110		01	100		1	30		90				1	2			90				30		31				51.79	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	031	0	1	01	01	H0838_031_0	10	Non-Preferred Brand	4	100000	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				58.70	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	031	0	1	01	01	H0838_031_0	10	Specialty Tier	4	100000	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 Diabetic Drugs												
H0838	031	0	1	01	01	H0838_031_0	10	Select Diabetic Drugs	4	000001	1	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, Select Diabetic Drugs												
H0838	032	0	1	01	01	H0838_032_0	12	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	032	0	1	01	01	H0838_032_0	12	Preferred Generic	4	001000	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs										1		
H0838	032	0	1	01	01	H0838_032_0	12	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	9.00		27.00																					18.00																9.00				9.00		0.30						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	032	0	1	01	01	H0838_032_0	12	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	45.00		135.00																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	032	0	1	01	01	H0838_032_0	12	Non-Preferred Brand	4	100000	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	90.00		270.00																					180.00																90.00				90.00		3.00						2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	032	0	1	01	01	H0838_032_0	12	Specialty Tier	4	100000	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 Diabetic Drugs												
H0838	032	0	1	01	01	H0838_032_0	12	Select Diabetic Drugs	4	000001	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	11.00		33.00																					22.00																11.00				11.00		0.37						0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	033	0	1	01	01	H0838_033_0	11	Preferred Generic	4	001000	1	1	1	1	110		01	100		1	30		90				1	2			90				30		31				0.00	0		0																				0															0			0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	033	0	1	01	01	H0838_033_0	11	Generic	4	010000	1	1	2	1	110		01	100		1	30		90				1	2			90				30		31				6.22	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	033	0	1	01	01	H0838_033_0	11	Preferred Brand	4	000001	1	1	3	1	110		01	100		1	30		90				1	2			90				30		31				53.41	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	033	0	1	01	01	H0838_033_0	11	Non-Preferred Brand	4	100000	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				58.36	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0838	033	0	1	01	01	H0838_033_0	11	Specialty Tier	4	100000	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 Diabetic Drugs												
H0838	033	0	1	01	01	H0838_033_0	11	Select Diabetic Drugs	4	000001	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	11.00		33.00																					22.00																11.00				11.00		0.37						0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H0913	002	0	1	01	01	H0913_002_0	5	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0913	002	0	1	01	01	H0913_002_0	5	Generic	4	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		50.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0913	002	0	1	01	01	H0913_002_0	5	Preferred Brand	4	000101	1	2	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												
H0913	002	0	1	01	01	H0913_002_0	5	Non-Preferred Drug	4	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				85.26	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0913	002	0	1	01	01	H0913_002_0	5	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				2370.93	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0913	012	0	1	01	01	H0913_012_0	5	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0913	012	0	1	01	01	H0913_012_0	5	Generic	4	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		50.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0913	012	0	1	01	01	H0913_012_0	5	Preferred Brand	4	000101	1	2	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												
H0913	012	0	1	01	01	H0913_012_0	5	Non-Preferred Drug	4	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				75.91	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0913	012	0	1	01	01	H0913_012_0	5	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				2448.02	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0913	013	0	1	01	01	H0913_013_0	5	Preferred Generic	2	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	2.00		6.00																									2.00		6.00				2.00		0.00				2.00				2.00		0.07				0.07	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0913	013	0	1	01	01	H0913_013_0	5	Generic	2	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		17.50				7.00				7.00		0.23				0.23	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0913	013	0	1	01	01	H0913_013_0	5	Preferred Brand	2	000101	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	33.00		99.00																									33.00		99.00				33.00		82.50				33.00				33.00		1.10				1.10	1.10	1.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0913	013	0	1	01	01	H0913_013_0	5	Non-Preferred Drug	2	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				98.72	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0913	013	0	1	01	01	H0913_013_0	5	Specialty Tier	2	010010	1	1	5	1	010		01		010	1	30											30			30		31				2118.33	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H0927	001	0	1	48	05	H0927_001_0	4	Generic Drugs	4	010001			1	1	110		01	100		1	30		90				1	2			90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0927	001	0	1	48	05	H0927_001_0	4	Brand Drugs	4	000110			2	1	110		01	100		1	30		90				1	2			90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H0927	001	0	1	48	05	H0927_001_0	4	Non-Medicare OTC Drugs	4	010010			3	1	110		01	100		1	30		90				1	2			90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H1016	001	0	1	01	01	H1016_001_0	13	Preferred Generic	4	001001	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	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	13	Preferred Generic	4	001001	3	2	1	3	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1016	001	0	1	01	01	H1016_001_0	13	Generic	4	010001	3	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	3.00	6.00	7.50																									3.00	6.00	9.00				3.00	6.00	7.50				3.00				3.00		0.10				0.10	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	001	0	1	01	01	H1016_001_0	13	Generic	4	010001	3	2	2	3	111		01		111	1	30	60	90				1	2				30	60	90	30		31	3.00	6.00	7.50																									3.00	6.00	9.00				3.00	6.00	7.50				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1016	001	0	1	01	01	H1016_001_0	13	Preferred Brand	4	010001	3	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	40.00	80.00	100.00																									40.00	80.00	120.00				40.00	80.00	100.00				40.00				40.00		1.33				1.33	1.33	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	001	0	1	01	01	H1016_001_0	13	Non-Preferred Drug	4	110000	3	2	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	75.00	150.00	187.50																									75.00	150.00	225.00				75.00	150.00	187.50				75.00				75.00		2.50				2.50	2.50	2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	001	0	1	01	01	H1016_001_0	13	Specialty Tier	4	010010	3	1	5	1	010		01			1	30														30		31				696.39	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	021	0	1	01	01	H1016_021_0	13	Preferred Generic	4	001001	3	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	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	13	Preferred Generic	4	001001	3	2	1	3	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1016	021	0	1	01	01	H1016_021_0	13	Generic	4	010001	3	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	7.00	14.00	17.50																									7.00	14.00	21.00				7.00	14.00	17.50				7.00				7.00		0.23				0.23	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	021	0	1	01	01	H1016_021_0	13	Generic	4	010001	3	2	2	3	111		01		111	1	30	60	90				1	2				30	60	90	30		31	7.00	14.00	17.50																									7.00	14.00	21.00				7.00	14.00	17.50				7.00				7.00		0.23				0.23	0.23	0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1016	021	0	1	01	01	H1016_021_0	13	Preferred Brand	4	010001	3	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	40.00	80.00	100.00																									40.00	80.00	120.00				40.00	80.00	100.00				40.00				40.00		1.33				1.33	1.33	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	021	0	1	01	01	H1016_021_0	13	Non-Preferred Drug	4	110000	3	2	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	75.00	150.00	187.50																									75.00	150.00	225.00				75.00	150.00	187.50				75.00				75.00		2.50				2.50	2.50	2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1016	021	0	1	01	01	H1016_021_0	13	Specialty Tier	4	010010	3	1	5	1	010		01			1	30														30		31				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	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0		0.17	0	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	001	0	1	01	01	H1019_001_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0		0.17	0	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1019	001	0	1	01	01	H1019_001_0	4	Generic	4	010001	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	001	0	1	01	01	H1019_001_0	4	Generic	4	010001	3	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1019	001	0	1	01	01	H1019_001_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					20.00		60.00											47.00		141.00				20.00		50.00				47.00				47.00			1.57	0.67		1.57	0.67	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	001	0	1	01	01	H1019_001_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					20.00		60.00											47.00		141.00				20.00		50.00				47.00				47.00			1.57	0.67		1.57	0.67	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1019	001	0	1	01	01	H1019_001_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					85.00		255.00											100.00		300.00				85.00		245.00				100.00				100.00			3.33	2.83		3.33	2.83	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	001	0	1	01	01	H1019_001_0	4	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					85.00		255.00											100.00		300.00				85.00		245.00				100.00				100.00			3.33	2.83		3.33	2.83	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1019	001	0	1	01	01	H1019_001_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	001	0	1	01	01	H1019_001_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1019	006	0	1	01	01	H1019_006_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	006	0	1	01	01	H1019_006_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1019	006	0	1	01	01	H1019_006_0	4	Generic	4	010001	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				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	006	0	1	01	01	H1019_006_0	4	Generic	4	010001	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				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1019	006	0	1	01	01	H1019_006_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	006	0	1	01	01	H1019_006_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1019	006	0	1	01	01	H1019_006_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								36.00		108.00					35.00		105.00											36.00		108.00				35.00		95.00				36.00				36.00			1.20	1.17		1.20	1.17	1.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	006	0	1	01	01	H1019_006_0	4	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								36.00		108.00					35.00		105.00											36.00		108.00				35.00		95.00				36.00				36.00			1.20	1.17		1.20	1.17	1.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1019	006	0	1	01	01	H1019_006_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	006	0	1	01	01	H1019_006_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1019	023	0	1	01	01	H1019_023_0	5	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	023	0	1	01	01	H1019_023_0	5	Generic	4	010001	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				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	023	0	1	01	01	H1019_023_0	5	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	023	0	1	01	01	H1019_023_0	5	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	023	0	1	01	01	H1019_023_0	5	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	024	0	1	01	01	H1019_024_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	024	0	1	01	01	H1019_024_0	4	Generic	4	010001	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				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	024	0	1	01	01	H1019_024_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	024	0	1	01	01	H1019_024_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	024	0	1	01	01	H1019_024_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	026	0	1	01	01	H1019_026_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	026	0	1	01	01	H1019_026_0	3	Generic	4	010001	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								11.00		33.00					6.00		18.00											11.00		33.00				6.00		0.00				11.00				11.00			0.37	0.20		0.37	0.20	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	026	0	1	01	01	H1019_026_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	026	0	1	01	01	H1019_026_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	026	0	1	01	01	H1019_026_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	028	0	1	01	01	H1019_028_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	028	0	1	01	01	H1019_028_0	4	Generic	4	010001	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								9.00		27.00					4.00		12.00											9.00		27.00				4.00		0.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	028	0	1	01	01	H1019_028_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	028	0	1	01	01	H1019_028_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	028	0	1	01	01	H1019_028_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	043	0	1	01	01	H1019_043_0	5	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	043	0	1	01	01	H1019_043_0	5	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1019	043	0	1	01	01	H1019_043_0	5	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								19.00		57.00					19.00		57.00											19.00		57.00				19.00		0.00				19.00				19.00			0.63	0.63		0.63	0.63	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	043	0	1	01	01	H1019_043_0	5	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								19.00		57.00					19.00		57.00											19.00		57.00				19.00		0.00				19.00				19.00			0.63	0.63		0.63	0.63	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1019	043	0	1	01	01	H1019_043_0	5	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	043	0	1	01	01	H1019_043_0	5	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1019	043	0	1	01	01	H1019_043_0	5	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	043	0	1	01	01	H1019_043_0	5	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1019	043	0	1	01	01	H1019_043_0	5	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	043	0	1	01	01	H1019_043_0	5	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1019	054	0	1	01	01	H1019_054_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	054	0	1	01	01	H1019_054_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1019	054	0	1	01	01	H1019_054_0	3	Generic	4	010001	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0		0.17	0	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	054	0	1	01	01	H1019_054_0	3	Generic	4	010001	3	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0		0.17	0	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1019	054	0	1	01	01	H1019_054_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		35.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	054	0	1	01	01	H1019_054_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		35.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1019	054	0	1	01	01	H1019_054_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								80.00		240.00					75.00		225.00											80.00		240.00				75.00		215.00				80.00				80.00			2.67	2.50		2.67	2.50	2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	054	0	1	01	01	H1019_054_0	3	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								80.00		240.00					75.00		225.00											80.00		240.00				75.00		215.00				80.00				80.00			2.67	2.50		2.67	2.50	2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1019	054	0	1	01	01	H1019_054_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	054	0	1	01	01	H1019_054_0	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1019	057	0	1	01	01	H1019_057_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	057	0	1	01	01	H1019_057_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1019	057	0	1	01	01	H1019_057_0	3	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	057	0	1	01	01	H1019_057_0	3	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1019	057	0	1	01	01	H1019_057_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								35.00		105.00					30.00		90.00											35.00		105.00				30.00		80.00				35.00				35.00			1.17	1		1.17	1	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	057	0	1	01	01	H1019_057_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								35.00		105.00					30.00		90.00											35.00		105.00				30.00		80.00				35.00				35.00			1.17	1		1.17	1	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1019	057	0	1	01	01	H1019_057_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								90.00		270.00					85.00		255.00											90.00		270.00				85.00		245.00				90.00				90.00			3	2.83		3	2.83	2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	057	0	1	01	01	H1019_057_0	3	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								90.00		270.00					85.00		255.00											90.00		270.00				85.00		245.00				90.00				90.00			3	2.83		3	2.83	2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1019	057	0	1	01	01	H1019_057_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	057	0	1	01	01	H1019_057_0	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1019	060	0	1	01	01	H1019_060_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	060	0	1	01	01	H1019_060_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1019	060	0	1	01	01	H1019_060_0	3	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	060	0	1	01	01	H1019_060_0	3	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1019	060	0	1	01	01	H1019_060_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								40.00		120.00					35.00		105.00											40.00		120.00				35.00		95.00				40.00				40.00			1.33	1.17		1.33	1.17	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	060	0	1	01	01	H1019_060_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								40.00		120.00					35.00		105.00											40.00		120.00				35.00		95.00				40.00				40.00			1.33	1.17		1.33	1.17	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1019	060	0	1	01	01	H1019_060_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								65.00		195.00					60.00		180.00											65.00		195.00				60.00		170.00				65.00				65.00			2.17	2		2.17	2	2.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	060	0	1	01	01	H1019_060_0	3	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								65.00		195.00					60.00		180.00											65.00		195.00				60.00		170.00				65.00				65.00			2.17	2		2.17	2	2.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1019	060	0	1	01	01	H1019_060_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	060	0	1	01	01	H1019_060_0	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1019	065	0	1	01	01	H1019_065_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	065	0	1	01	01	H1019_065_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1019	065	0	1	01	01	H1019_065_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	065	0	1	01	01	H1019_065_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1019	065	0	1	01	01	H1019_065_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	065	0	1	01	01	H1019_065_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1019	065	0	1	01	01	H1019_065_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	065	0	1	01	01	H1019_065_0	4	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1019	065	0	1	01	01	H1019_065_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	065	0	1	01	01	H1019_065_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1019	069	0	1	01	01	H1019_069_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0		0.17	0	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	069	0	1	01	01	H1019_069_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0		0.17	0	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1019	069	0	1	01	01	H1019_069_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								15.00		45.00					10.00		30.00											15.00		45.00				10.00		0.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	069	0	1	01	01	H1019_069_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								15.00		45.00					10.00		30.00											15.00		45.00				10.00		0.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1019	069	0	1	01	01	H1019_069_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	069	0	1	01	01	H1019_069_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1019	069	0	1	01	01	H1019_069_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	069	0	1	01	01	H1019_069_0	4	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1019	069	0	1	01	01	H1019_069_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	069	0	1	01	01	H1019_069_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1019	073	0	1	01	01	H1019_073_0	4	Preferred Generic	3	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	073	0	1	01	01	H1019_073_0	4	Generic	3	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								11.00		33.00					6.00		18.00											11.00		33.00				6.00		0.00				11.00				11.00			0.37	0.20		0.37	0.20	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	073	0	1	01	01	H1019_073_0	4	Preferred Brand	3	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	073	0	1	01	01	H1019_073_0	4	Non-Preferred Drug	3	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	073	0	1	01	01	H1019_073_0	4	Specialty Tier	3	010010	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	076	0	1	01	01	H1019_076_0	5	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	076	0	1	01	01	H1019_076_0	5	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1019	076	0	1	01	01	H1019_076_0	5	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	076	0	1	01	01	H1019_076_0	5	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1019	076	0	1	01	01	H1019_076_0	5	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	076	0	1	01	01	H1019_076_0	5	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1019	076	0	1	01	01	H1019_076_0	5	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	076	0	1	01	01	H1019_076_0	5	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1019	076	0	1	01	01	H1019_076_0	5	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	076	0	1	01	01	H1019_076_0	5	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1019	077	0	1	01	01	H1019_077_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	077	0	1	01	01	H1019_077_0	3	Generic	4	010001	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								9.00		27.00					4.00		12.00											9.00		27.00				4.00		0.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	077	0	1	01	01	H1019_077_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	077	0	1	01	01	H1019_077_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	077	0	1	01	01	H1019_077_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	079	0	1	01	01	H1019_079_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	079	0	1	01	01	H1019_079_0	3	Generic	4	010001	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								8.00		24.00					3.00		9.00											8.00		24.00				3.00		0.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	079	0	1	01	01	H1019_079_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	079	0	1	01	01	H1019_079_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	079	0	1	01	01	H1019_079_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	081	0	1	01	01	H1019_081_0	6	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	081	0	1	01	01	H1019_081_0	6	Generic	4	010001	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				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	081	0	1	01	01	H1019_081_0	6	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	081	0	1	01	01	H1019_081_0	6	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	081	0	1	01	01	H1019_081_0	6	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	083	0	1	01	01	H1019_083_0	5	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	083	0	1	01	01	H1019_083_0	5	Generic	4	010001	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				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	083	0	1	01	01	H1019_083_0	5	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	083	0	1	01	01	H1019_083_0	5	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	083	0	1	01	01	H1019_083_0	5	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	085	0	1	01	01	H1019_085_0	7	Preferred Generic	3	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	085	0	1	01	01	H1019_085_0	7	Generic	3	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								14.00		42.00					9.00		27.00											14.00		42.00				9.00		0.00				14.00				14.00			0.47	0.30		0.47	0.30	0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	085	0	1	01	01	H1019_085_0	7	Preferred Brand	3	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	085	0	1	01	01	H1019_085_0	7	Non-Preferred Drug	3	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1019	085	0	1	01	01	H1019_085_0	7	Specialty Tier	3	010010	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1026	001	0	1	01	01	H1026_001_0	10	Preferred Generic	4	001000	1	2	1	1		110	01	110		1				31		90	1	1	31		90				31		31								7.00		21.00					0.00		0.00					0.00		0.00																7.00				0.00			0.23	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	001	0	1	01	01	H1026_001_0	10	Preferred Generic	4	001000	1	2	1	3		110	01	110		1				31		90	1	1	31		90				31		31								7.00		21.00					0.00		0.00					0.00		0.00																7.00				0.00			0.23	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1026	001	0	1	01	01	H1026_001_0	10	Generic	4	010000	1	2	2	1		110	01	110		1				31		90	1	1	31		90				31		31								15.00		45.00					8.00		24.00					8.00		24.00																15.00				8.00			0.48	0.26	0.26			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	001	0	1	01	01	H1026_001_0	10	Generic	4	010000	1	2	2	3		110	01	110		1				31		90	1	1	31		90				31		31								15.00		45.00					8.00		24.00					8.00		24.00																15.00				8.00			0.48	0.26	0.26			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1026	001	0	1	01	01	H1026_001_0	10	Preferred Brand	4	010001	1	2	3	1		110	01	110		1				31		90	1	1	31		90				31		31								47.00		141.00					40.00		120.00					40.00		120.00																47.00				40.00			1.52	1.29	1.29			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	001	0	1	01	01	H1026_001_0	10	Non-Preferred Brand	4	110000	1	2	4	1		110	01	110		1				31		90	1	1	31		90				31		31								100.00		300.00					93.00		279.00					93.00		279.00																100.00				93.00			3.23	3.00	3.00			3.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	001	0	1	01	01	H1026_001_0	10	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				31					31						31		31											582.02	33						582.02	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	038	0	1	01	01	H1026_038_0	9	Preferred Generic	4	001000	1	2	1	1		110	01	110		1				31		90	1	1	31		90				31		31								14.00		42.00					7.00		21.00					7.00		21.00																14.00				7.00			0.45	0.23	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	038	0	1	01	01	H1026_038_0	9	Preferred Generic	4	001000	1	2	1	3		110	01	110		1				31		90	1	1	31		90				31		31								14.00		42.00					7.00		21.00					7.00		21.00																14.00				7.00			0.45	0.23	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1026	038	0	1	01	01	H1026_038_0	9	Generic	4	010000	1	2	2	1		110	01	110		1				31		90	1	1	31		90				31		31								20.00		60.00					13.00		39.00					13.00		39.00																20.00				13.00			0.65	0.42	0.42			0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	038	0	1	01	01	H1026_038_0	9	Generic	4	010000	1	2	2	3		110	01	110		1				31		90	1	1	31		90				31		31								20.00		60.00					13.00		39.00					13.00		39.00																20.00				13.00			0.65	0.42	0.42			0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1026	038	0	1	01	01	H1026_038_0	9	Preferred Brand	4	010001	1	2	3	1		110	01	110		1				31		90	1	1	31		90				31		31								47.00		141.00					40.00		120.00					40.00		120.00																47.00				40.00			1.52	1.29	1.29			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	038	0	1	01	01	H1026_038_0	9	Non-Preferred Brand	4	110000	1	2	4	1		110	01	110		1				31		90	1	1	31		90				31		31								100.00		300.00					93.00		279.00					93.00		279.00																100.00				93.00			3.23	3.00	3.00			3.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	038	0	1	01	01	H1026_038_0	9	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				31					31						31		31											581.55	33						581.55	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	040	0	1	01	01	H1026_040_0	9	Preferred Generic	4	001000	1	2	1	1		110	01	110		1				31		90	1	1	31		90				31		31								12.00		36.00					5.00		15.00					5.00		15.00																12.00				5.00			0.39	0.16	0.16			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	040	0	1	01	01	H1026_040_0	9	Preferred Generic	4	001000	1	2	1	3		110	01	110		1				31		90	1	1	31		90				31		31								12.00		36.00					5.00		15.00					5.00		15.00																12.00				5.00			0.39	0.16	0.16			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1026	040	0	1	01	01	H1026_040_0	9	Generic	4	010000	1	2	2	1		110	01	110		1				31		90	1	1	31		90				31		31								20.00		60.00					13.00		39.00					13.00		39.00																20.00				13.00			0.65	0.42	0.42			0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	040	0	1	01	01	H1026_040_0	9	Preferred Brand	4	010001	1	2	3	1		110	01	110		1				31		90	1	1	31		90				31		31								47.00		141.00					40.00		120.00					40.00		120.00																47.00				40.00			1.52	1.29	1.29			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	040	0	1	01	01	H1026_040_0	9	Non-Preferred Brand	4	110000	1	2	4	1		110	01	110		1				31		90	1	1	31		90				31		31								100.00		300.00					93.00		279.00					93.00		279.00																100.00				93.00			3.23	3.00	3.00			3.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	040	0	1	01	01	H1026_040_0	9	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				31					31						31		31											610.26	33						610.26	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	056	0	1	01	01	H1026_056_0	9	Preferred Generic	4	001000	1	2	1	1		110	01	110		1				31		90	1	1	31		90				31		31								17.00		51.00					10.00		30.00					10.00		30.00																17.00				10.00			0.55	0.32	0.32			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	056	0	1	01	01	H1026_056_0	9	Preferred Generic	4	001000	1	2	1	3		110	01	110		1				31		90	1	1	31		90				31		31								17.00		51.00					10.00		30.00					10.00		30.00																17.00				10.00			0.55	0.32	0.32			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1026	056	0	1	01	01	H1026_056_0	9	Generic	4	010000	1	2	2	1		110	01	110		1				31		90	1	1	31		90				31		31								20.00		60.00					13.00		39.00					13.00		39.00																20.00				13.00			0.65	0.42	0.42			0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	056	0	1	01	01	H1026_056_0	9	Generic	4	010000	1	2	2	3		110	01	110		1				31		90	1	1	31		90				31		31								20.00		60.00					13.00		39.00					13.00		39.00																20.00				13.00			0.65	0.42	0.42			0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1026	056	0	1	01	01	H1026_056_0	9	Preferred Brand	4	010001	1	2	3	1		110	01	110		1				31		90	1	1	31		90				31		31								47.00		141.00					40.00		120.00					40.00		120.00																47.00				40.00			1.52	1.29	1.29			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	056	0	1	01	01	H1026_056_0	9	Non-Preferred Brand	4	110000	1	2	4	1		110	01	110		1				31		90	1	1	31		90				31		31								100.00		300.00					93.00		279.00					93.00		279.00																100.00				93.00			3.23	3.00	3.00			3.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	056	0	1	01	01	H1026_056_0	9	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				31					31						31		31											636.62	33						636.62	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	057	0	1	01	01	H1026_057_0	9	Preferred Generic	4	001000	1	2	1	1		110	01	110		1				31		90	1	1	31		90				31		31								11.00		33.00					4.00		12.00					4.00		12.00																11.00				4.00			0.35	0.13	0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	057	0	1	01	01	H1026_057_0	9	Preferred Generic	4	001000	1	2	1	3		110	01	110		1				31		90	1	1	31		90				31		31								11.00		33.00					4.00		12.00					4.00		12.00																11.00				4.00			0.35	0.13	0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1026	057	0	1	01	01	H1026_057_0	9	Generic	4	010000	1	2	2	1		110	01	110		1				31		90	1	1	31		90				31		31								20.00		60.00					13.00		39.00					13.00		39.00																20.00				13.00			0.65	0.42	0.42			0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	057	0	1	01	01	H1026_057_0	9	Generic	4	010000	1	2	2	3		110	01	110		1				31		90	1	1	31		90				31		31								20.00		60.00					13.00		39.00					13.00		39.00																20.00				13.00			0.65	0.42	0.42			0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1026	057	0	1	01	01	H1026_057_0	9	Preferred Brand	4	010001	1	2	3	1		110	01	110		1				31		90	1	1	31		90				31		31								47.00		141.00					40.00		120.00					40.00		120.00																47.00				40.00			1.52	1.29	1.29			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	057	0	1	01	01	H1026_057_0	9	Non-Preferred Brand	4	110000	1	2	4	1		110	01	110		1				31		90	1	1	31		90				31		31								100.00		300.00					93.00		279.00					93.00		279.00																100.00				93.00			3.23	3.00	3.00			3.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	057	0	1	01	01	H1026_057_0	9	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				31					31						31		31											610.26	33						610.26	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	058	0	1	01	01	H1026_058_0	9	Preferred Generic	4	001000	1	2	1	1		110	01	110		1				31		90	1	1	31		90				31		31								7.00		21.00					0.00		0.00					0.00		0.00																7.00				0.00			0.23	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	058	0	1	01	01	H1026_058_0	9	Preferred Generic	4	001000	1	2	1	3		110	01	110		1				31		90	1	1	31		90				31		31								7.00		21.00					0.00		0.00					0.00		0.00																7.00				0.00			0.23	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1026	058	0	1	01	01	H1026_058_0	9	Generic	4	010000	1	2	2	1		110	01	110		1				31		90	1	1	31		90				31		31								12.00		36.00					5.00		15.00					5.00		15.00																12.00				5.00			0.39	0.16	0.16			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	058	0	1	01	01	H1026_058_0	9	Generic	4	010000	1	2	2	3		110	01	110		1				31		90	1	1	31		90				31		31								12.00		36.00					5.00		15.00					5.00		15.00																12.00				5.00			0.39	0.16	0.16			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1026	058	0	1	01	01	H1026_058_0	9	Preferred Brand	4	010001	1	2	3	1		110	01	110		1				31		90	1	1	31		90				31		31								47.00		141.00					40.00		120.00					40.00		120.00																47.00				40.00			1.52	1.29	1.29			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	058	0	1	01	01	H1026_058_0	9	Non-Preferred Brand	4	110000	1	2	4	1		110	01	110		1				31		90	1	1	31		90				31		31								100.00		300.00					93.00		279.00					93.00		279.00																100.00				93.00			3.23	3.00	3.00			3.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	058	0	1	01	01	H1026_058_0	9	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				31					31						31		31											528.24	33						528.24	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	059	0	1	01	01	H1026_059_0	9	Preferred Generic	4	001000	1	2	1	1		110	01	110		1				31		90	1	1	31		90				31		31								7.00		21.00					0.00		0.00					0.00		0.00																7.00				0.00			0.23	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	059	0	1	01	01	H1026_059_0	9	Preferred Generic	4	001000	1	2	1	3		110	01	110		1				31		90	1	1	31		90				31		31								7.00		21.00					0.00		0.00					0.00		0.00																7.00				0.00			0.23	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1026	059	0	1	01	01	H1026_059_0	9	Generic	4	010000	1	2	2	1		110	01	110		1				31		90	1	1	31		90				31		31								12.00		36.00					5.00		15.00					5.00		15.00																12.00				5.00			0.39	0.16	0.16			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	059	0	1	01	01	H1026_059_0	9	Generic	4	010000	1	2	2	3		110	01	110		1				31		90	1	1	31		90				31		31								12.00		36.00					5.00		15.00					5.00		15.00																12.00				5.00			0.39	0.16	0.16			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1026	059	0	1	01	01	H1026_059_0	9	Preferred Brand	4	010001	1	2	3	1		110	01	110		1				31		90	1	1	31		90				31		31								42.00		126.00					35.00		105.00					35.00		105.00																42.00				35.00			1.35	1.13	1.13			1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	059	0	1	01	01	H1026_059_0	9	Non-Preferred Brand	4	110000	1	2	4	1		110	01	110		1				31		90	1	1	31		90				31		31								87.00		261.00					80.00		240.00					80.00		240.00																87.00				80.00			2.81	2.58	2.58			2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	059	0	1	01	01	H1026_059_0	9	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				31					31						31		31											528.24	33						528.24	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	060	0	1	01	01	H1026_060_0	13	Preferred Generic	4	001000	1	2	1	1		110	01	110		1				31		90	1	1	31		90				31		31								7.00		21.00					0.00		0.00					0.00		0.00																7.00				0.00			0.23	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	060	0	1	01	01	H1026_060_0	13	Preferred Generic	4	001000	1	2	1	3		110	01	110		1				31		90	1	1	31		90				31		31								7.00		21.00					0.00		0.00					0.00		0.00																7.00				0.00			0.23	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1026	060	0	1	01	01	H1026_060_0	13	Generic	4	010000	1	2	2	1		110	01	110		1				31		90	1	1	31		90				31		31								10.00		30.00					0.00		0.00					0.00		0.00																10.00				0.00			0.32	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	060	0	1	01	01	H1026_060_0	13	Generic	4	010000	1	2	2	3		110	01	110		1				31		90	1	1	31		90				31		31								10.00		30.00					0.00		0.00					0.00		0.00																10.00				0.00			0.32	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1026	060	0	1	01	01	H1026_060_0	13	Preferred Brand	4	010001	1	2	3	1		110	01	110		1				31		90	1	1	31		90				31		31								25.00		75.00					15.00		45.00					15.00		45.00																25.00				15.00			0.81	0.48	0.48			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	060	0	1	01	01	H1026_060_0	13	Non-Preferred Brand	4	110000	1	2	4	1		110	01	110		1				31		90	1	1	31		90				31		31								55.00		165.00					45.00		135.00					45.00		135.00																55.00				45.00			1.77	1.45	1.45			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	060	0	1	01	01	H1026_060_0	13	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				31					31						31		31											582.02	33						582.02	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	061	0	1	01	01	H1026_061_0	8	Preferred Generic	4	001000	1	2	1	1		110	01	110		1				31		90	1	1	31		90				31		31								10.00		30.00					0.00		0.00					0.00		0.00																10.00				0.00			0.32	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	061	0	1	01	01	H1026_061_0	8	Preferred Generic	4	001000	1	2	1	3		110	01	110		1				31		90	1	1	31		90				31		31								10.00		30.00					0.00		0.00					0.00		0.00																10.00				0.00			0.32	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1026	061	0	1	01	01	H1026_061_0	8	Generic	4	010000	1	2	2	1		110	01	110		1				31		90	1	1	31		90				31		31								15.00		45.00					5.00		15.00					5.00		15.00																15.00				5.00			0.48	0.16	0.16			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	061	0	1	01	01	H1026_061_0	8	Generic	4	010000	1	2	2	3		110	01	110		1				31		90	1	1	31		90				31		31								15.00		45.00					5.00		15.00					5.00		15.00																15.00				5.00			0.48	0.16	0.16			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1026	061	0	1	01	01	H1026_061_0	8	Preferred Brand	4	010001	1	2	3	1		110	01	110		1				31		90	1	1	31		90				31		31								45.00		135.00					35.00		105.00					35.00		105.00																45.00				35.00			1.45	1.13	1.13			1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	061	0	1	01	01	H1026_061_0	8	Non-Preferred Brand	4	110000	1	2	4	1		110	01	110		1				31		90	1	1	31		90				31		31								75.00		225.00					65.00		195.00					65.00		195.00																75.00				65.00			2.42	2.10	2.10			2.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	061	0	1	01	01	H1026_061_0	8	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				31					31						31		31											582.02	33						582.02	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	062	0	1	01	01	H1026_062_0	9	Preferred Generic	4	001000	1	2	1	1		110	01	110		1				31		90	1	1	31		90				31		31								10.00		30.00					0.00		0.00					0.00		0.00																10.00				0.00			0.32	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	062	0	1	01	01	H1026_062_0	9	Preferred Generic	4	001000	1	2	1	3		110	01	110		1				31		90	1	1	31		90				31		31								10.00		30.00					0.00		0.00					0.00		0.00																10.00				0.00			0.32	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1026	062	0	1	01	01	H1026_062_0	9	Generic	4	010000	1	2	2	1		110	01	110		1				31		90	1	1	31		90				31		31								15.00		45.00					5.00		15.00					5.00		15.00																15.00				5.00			0.48	0.16	0.16			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	062	0	1	01	01	H1026_062_0	9	Generic	4	010000	1	2	2	3		110	01	110		1				31		90	1	1	31		90				31		31								15.00		45.00					5.00		15.00					5.00		15.00																15.00				5.00			0.48	0.16	0.16			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1026	062	0	1	01	01	H1026_062_0	9	Preferred Brand	4	010001	1	2	3	1		110	01	110		1				31		90	1	1	31		90				31		31								47.00		141.00					37.00		111.00					37.00		111.00																47.00				37.00			1.52	1.19	1.19			1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	062	0	1	01	01	H1026_062_0	9	Non-Preferred Brand	4	110000	1	2	4	1		110	01	110		1				31		90	1	1	31		90				31		31								95.00		285.00					85.00		255.00					85.00		255.00																95.00				85.00			3.06	2.74	2.74			2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1026	062	0	1	01	01	H1026_062_0	9	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				31					31						31		31											528.24	33						528.24	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1032	032	0	1	01	01	H1032_032_0	5	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	032	0	1	01	01	H1032_032_0	5	Generic	4	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	032	0	1	01	01	H1032_032_0	5	Preferred Brand	4	000101	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		62.50				25.00				25.00		0.83				0.83	0.83	0.81	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	032	0	1	01	01	H1032_032_0	5	Non-Preferred Drug	4	100100	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		187.50				75.00				75.00		2.50				2.50	2.50	2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	032	0	1	01	01	H1032_032_0	5	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				2709.87	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	040	0	1	01	01	H1032_040_0	4	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	040	0	1	01	01	H1032_040_0	4	Generic	4	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	040	0	1	01	01	H1032_040_0	4	Preferred Brand	4	000101	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		62.50				25.00				25.00		0.83				0.83	0.83	0.81	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	040	0	1	01	01	H1032_040_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	50.00		150.00																									50.00		150.00				50.00		125.00				50.00				50.00		1.67				1.67	1.67	1.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	040	0	1	01	01	H1032_040_0	4	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				2603.58	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	061	0	1	01	01	H1032_061_0	4	Preferred Generic	3	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	061	0	1	01	01	H1032_061_0	4	Generic	3	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		50.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	061	0	1	01	01	H1032_061_0	4	Preferred Brand	3	000101	1	2	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												
H1032	061	0	1	01	01	H1032_061_0	4	Non-Preferred Drug	3	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				92.24	47		47																								47		47				47		47			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	061	0	1	01	01	H1032_061_0	4	Specialty Tier	3	010010	1	1	5	1	010		01		010	1	30											30			30		31				2384.19	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	073	0	1	01	01	H1032_073_0	5	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	073	0	1	01	01	H1032_073_0	5	Generic	4	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		12.50				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	073	0	1	01	01	H1032_073_0	5	Preferred Brand	4	000101	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	35.00		105.00																									35.00		105.00				35.00		87.50				35.00				35.00		1.17				1.17	1.17	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	073	0	1	01	01	H1032_073_0	5	Non-Preferred Drug	4	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				73.40	47		47																								47		47				47		47			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	073	0	1	01	01	H1032_073_0	5	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				2469.74	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	079	0	1	02	01	H1032_079_0	4	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	079	0	1	02	01	H1032_079_0	4	Generic	4	010001	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		25.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	079	0	1	02	01	H1032_079_0	4	Preferred Brand	4	000101	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	40.00		120.00																									40.00		120.00				40.00		100.00				40.00				40.00		1.33				1.33	1.33	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	079	0	1	02	01	H1032_079_0	4	Non-Preferred Drug	4	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				64.65	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	079	0	1	02	01	H1032_079_0	4	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				2827.53	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	091	0	1	02	01	H1032_091_0	4	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	091	0	1	02	01	H1032_091_0	4	Generic	4	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	091	0	1	02	01	H1032_091_0	4	Preferred Brand	4	000101	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	35.00		105.00																									35.00		105.00				35.00		87.50				35.00				35.00		1.17				1.17	1.17	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	091	0	1	02	01	H1032_091_0	4	Non-Preferred Drug	4	100100	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		187.50				75.00				75.00		2.50				2.50	2.50	2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	091	0	1	02	01	H1032_091_0	4	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				2822.58	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	124	0	1	01	01	H1032_124_0	4	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	124	0	1	01	01	H1032_124_0	4	Generic	4	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		50.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	124	0	1	01	01	H1032_124_0	4	Preferred Brand	4	000101	1	2	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												
H1032	124	0	1	01	01	H1032_124_0	4	Non-Preferred Drug	4	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				91.69	47		47																								47		47				47		47			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	124	0	1	01	01	H1032_124_0	4	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				2404.47	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	133	0	1	02	01	H1032_133_0	4	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	133	0	1	02	01	H1032_133_0	4	Generic	4	010001	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		25.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	133	0	1	02	01	H1032_133_0	4	Preferred Brand	4	000101	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		112.50				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	133	0	1	02	01	H1032_133_0	4	Non-Preferred Drug	4	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				66.91	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	133	0	1	02	01	H1032_133_0	4	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				2612.02	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	170	0	1	01	01	H1032_170_0	4	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	170	0	1	01	01	H1032_170_0	4	Generic	4	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		50.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	170	0	1	01	01	H1032_170_0	4	Preferred Brand	4	000101	1	2	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												
H1032	170	0	1	01	01	H1032_170_0	4	Non-Preferred Drug	4	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				98.95	41		41																								41		41				41		41			41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	170	0	1	01	01	H1032_170_0	4	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				2293.23	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	174	0	1	02	01	H1032_174_0	4	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	174	0	1	02	01	H1032_174_0	4	Generic	4	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	174	0	1	02	01	H1032_174_0	4	Preferred Brand	4	000101	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		37.50				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	174	0	1	02	01	H1032_174_0	4	Non-Preferred Drug	4	100100	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		187.50				75.00				75.00		2.50				2.50	2.50	2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	174	0	1	02	01	H1032_174_0	4	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				2963.98	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	175	0	1	01	01	H1032_175_0	4	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	175	0	1	01	01	H1032_175_0	4	Generic	4	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		50.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	175	0	1	01	01	H1032_175_0	4	Preferred Brand	4	000101	1	2	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												
H1032	175	0	1	01	01	H1032_175_0	4	Non-Preferred Drug	4	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				96.16	49		49																								49		49				49		49			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	175	0	1	01	01	H1032_175_0	4	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				2294.44	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	176	0	1	01	01	H1032_176_0	4	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	176	0	1	01	01	H1032_176_0	4	Generic	4	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		50.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	176	0	1	01	01	H1032_176_0	4	Preferred Brand	4	000101	1	2	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												
H1032	176	0	1	01	01	H1032_176_0	4	Non-Preferred Drug	4	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				98.79	46		46																								46		46				46		46			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	176	0	1	01	01	H1032_176_0	4	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				2048.19	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	179	0	1	01	01	H1032_179_0	7	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	179	0	1	01	01	H1032_179_0	7	Generic	4	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	179	0	1	01	01	H1032_179_0	7	Preferred Brand	4	000101	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	35.00		105.00																									35.00		105.00				35.00		87.50				35.00				35.00		1.17				1.17	1.17	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	179	0	1	01	01	H1032_179_0	7	Non-Preferred Drug	4	100100	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		187.50				75.00				75.00		2.50				2.50	2.50	2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	179	0	1	01	01	H1032_179_0	7	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				2809.53	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	180	0	1	01	01	H1032_180_0	5	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	180	0	1	01	01	H1032_180_0	5	Generic	4	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		15.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	180	0	1	01	01	H1032_180_0	5	Preferred Brand	4	000101	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	37.00		111.00																									37.00		111.00				37.00		92.50				37.00				37.00		1.23				1.23	1.23	1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	180	0	1	01	01	H1032_180_0	5	Non-Preferred Drug	4	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				70.12	46		46																								46		46				46		46			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	180	0	1	01	01	H1032_180_0	5	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				2404.78	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	182	0	1	01	01	H1032_182_0	4	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	182	0	1	01	01	H1032_182_0	4	Generic	4	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		50.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	182	0	1	01	01	H1032_182_0	4	Preferred Brand	4	000101	1	2	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												
H1032	182	0	1	01	01	H1032_182_0	4	Non-Preferred Drug	4	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				98.30	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	182	0	1	01	01	H1032_182_0	4	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				2368.24	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	183	0	1	01	01	H1032_183_0	4	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	183	0	1	01	01	H1032_183_0	4	Generic	4	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		50.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	183	0	1	01	01	H1032_183_0	4	Preferred Brand	4	000101	1	2	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												
H1032	183	0	1	01	01	H1032_183_0	4	Non-Preferred Drug	4	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				94.37	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1032	183	0	1	01	01	H1032_183_0	4	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				2317.95	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1035	002	0	1	02	01	H1035_002_0	7	Preferred Generic	4	001000	1	2	1	1		110	01	100		1				31		93	1	1			93				31		31								10.00		30.00					0.00		0.00							0.00																10.00				10.00			0.32	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H1035	002	0	1	02	01	H1035_002_0	7	Preferred Generic	4	001000	1	2	1	3		110	01	100		1				31		93	1	1			93				31		31								10.00		30.00					0.00		0.00							0.00																10.00				10.00			0.32	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
H1035	002	0	1	02	01	H1035_002_0	7	Generic	4	010000	1	2	2	1		110	01	100		1				31		93	2	1			93				31		31								17.00		51.00					4.00		12.00							9.00																17.00				17.00			0.55	0.13				0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H1035	002	0	1	02	01	H1035_002_0	7	Generic	4	010000	1	2	2	3		110	01	100		1				31		93	2	1			93				31		31								17.00		51.00					4.00		12.00							9.00																17.00				17.00			0.55	0.13				0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
H1035	002	0	1	02	01	H1035_002_0	7	Preferred Brand	4	000001	1	2	3	1		110	01	100		1				31		93	2	1			93				31		31								45.00		135.00					40.00		120.00							117.00																45.00				45.00			1.45	1.29				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H1035	002	0	1	02	01	H1035_002_0	7	Non-Preferred Brand	4	100000	1	2	4	1		110	01	100		1				31		93	2	1			93				31		31								95.00		285.00					80.00		240.00							237.00																95.00				95.00			3.06	2.58				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H1035	002	0	1	02	01	H1035_002_0	7	Injectable Drugs	4	010010	1	1	5	1		010	01			1				31											31		31											56.27	33						39.20	25																							33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H1035	002	0	1	02	01	H1035_002_0	7	Specialty Tier	4	010010	1	1	6	1		010	01			1				31											31		31											862.13	33						715.63	33																							33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H1035	006	0	1	01	01	H1035_006_0	7	Preferred Generic	4	001000	1	2	1	1		110	01	100		1				31		93	1	1			93				31		31								10.00		30.00					2.00		6.00							3.00																10.00				10.00			0.32	0.06				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H1035	006	0	1	01	01	H1035_006_0	7	Generic	4	010000	1	2	2	1		110	01	100		1				31		93	2	1			93				31		31								17.00		51.00					7.00		21.00							18.00																17.00				17.00			0.55	0.23				0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H1035	006	0	1	01	01	H1035_006_0	7	Preferred Brand	4	000001	1	2	3	1		110	01	100		1				31		93	2	1			93				31		31								47.00		141.00					42.00		126.00							123.00																47.00				47.00			1.52	1.35				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H1035	006	0	1	01	01	H1035_006_0	7	Non-Preferred Brand	4	100000	1	2	4	1		110	01	100		1				31		93	2	1			93				31		31								95.00		285.00					80.00		240.00							237.00																95.00				95.00			3.06	2.58				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H1035	006	0	1	01	01	H1035_006_0	7	Injectable Drugs	4	010010	1	1	5	1		010	01			1				31											31		31											68.55	29						24.97	25																							29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H1035	006	0	1	01	01	H1035_006_0	7	Specialty Tier	4	010010	1	1	6	1		010	01			1				31											31		31											807.23	29						900.91	29																							29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H1035	010	0	1	01	01	H1035_010_0	4	Preferred Generic	4	001000	1	2	1	1		110	01	100		1				31		93	1	1			93				31		31								10.00		30.00					2.00		6.00							3.00																10.00				10.00			0.32	0.06				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H1035	010	0	1	01	01	H1035_010_0	4	Generic	4	010000	1	2	2	1		110	01	100		1				31		93	2	1			93				31		31								17.00		51.00					7.00		21.00							18.00																17.00				17.00			0.55	0.23				0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H1035	010	0	1	01	01	H1035_010_0	4	Preferred Brand	4	000001	1	2	3	1		110	01	100		1				31		93	2	1			93				31		31								45.00		135.00					40.00		120.00							117.00																45.00				45.00			1.45	1.29				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H1035	010	0	1	01	01	H1035_010_0	4	Non-Preferred Brand	4	100000	1	2	4	1		110	01	100		1				31		93	2	1			93				31		31								95.00		285.00					80.00		240.00							237.00																95.00				95.00			3.06	2.58				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H1035	010	0	1	01	01	H1035_010_0	4	Injectable Drugs	4	010010	1	1	5	1		010	01			1				31											31		31											862.13	25						715.63	25																							25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H1035	010	0	1	01	01	H1035_010_0	4	Specialty Tier	4	010010	1	1	6	1		010	01			1				31											31		31											56.27	33						39.20	33																							33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H1035	011	0	1	02	01	H1035_011_0	5	Preferred Generic	4	001000	1	2	1	1		110	01	100		1				31		93	1	1			93				31		31								10.00		30.00					0.00		0.00							0.00																10.00				10.00			0.32	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H1035	011	0	1	02	01	H1035_011_0	5	Preferred Generic	4	001000	1	2	1	3		110	01	100		1				31		93	1	1			93				31		31								10.00		30.00					0.00		0.00							0.00																10.00				10.00			0.32	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
H1035	011	0	1	02	01	H1035_011_0	5	Generic	4	010000	1	2	2	1		110	01	100		1				31		93	2	1			93				31		31								17.00		51.00					7.00		21.00							18.00																17.00				17.00			0.55	0.23				0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H1035	011	0	1	02	01	H1035_011_0	5	Generic	4	010000	1	2	2	3		110	01	100		1				31		93	2	1			93				31		31								17.00		51.00					7.00		21.00							18.00																17.00				17.00			0.55	0.23				0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
H1035	011	0	1	02	01	H1035_011_0	5	Preferred Brand	4	000001	1	2	3	1		110	01	100		1				31		93	2	1			93				31		31								45.00		135.00					40.00		120.00							117.00																45.00				45.00			1.45	1.29				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H1035	011	0	1	02	01	H1035_011_0	5	Non-Preferred Brand	4	100000	1	2	4	1		110	01	100		1				31		93	2	1			93				31		31								95.00		285.00					80.00		240.00							237.00																95.00				95.00			3.06	2.58				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H1035	011	0	1	02	01	H1035_011_0	5	Injectable Drugs	4	010010	1	1	5	1		010	01			1				31											31		31											862.13	25						715.63	25																							25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H1035	011	0	1	02	01	H1035_011_0	5	Specialty Tier	4	010010	1	1	6	1		010	01			1				31											31		31											56.27	33						39.20	33																							33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H1036	025	0	1	01	01	H1036_025_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	025	0	1	01	01	H1036_025_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1036	025	0	1	01	01	H1036_025_0	3	Generic	4	010001	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0		0.17	0	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	025	0	1	01	01	H1036_025_0	3	Generic	4	010001	3	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0		0.17	0	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1036	025	0	1	01	01	H1036_025_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		35.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	025	0	1	01	01	H1036_025_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		35.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	025	0	1	01	01	H1036_025_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								65.00		195.00					60.00		180.00											65.00		195.00				60.00		170.00				65.00				65.00			2.17	2		2.17	2	2.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	025	0	1	01	01	H1036_025_0	3	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								65.00		195.00					60.00		180.00											65.00		195.00				60.00		170.00				65.00				65.00			2.17	2		2.17	2	2.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	025	0	1	01	01	H1036_025_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	025	0	1	01	01	H1036_025_0	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	040	0	1	01	01	H1036_040_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	040	0	1	01	01	H1036_040_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1036	040	0	1	01	01	H1036_040_0	3	Generic	4	010001	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0		0.17	0	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	040	0	1	01	01	H1036_040_0	3	Generic	4	010001	3	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0		0.17	0	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1036	040	0	1	01	01	H1036_040_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								15.00		45.00					10.00		30.00											15.00		45.00				10.00		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												
H1036	040	0	1	01	01	H1036_040_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								15.00		45.00					10.00		30.00											15.00		45.00				10.00		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										2	3	
H1036	040	0	1	01	01	H1036_040_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								60.00		180.00					55.00		165.00											60.00		180.00				55.00		155.00				60.00				60.00			2	1.83		2	1.83	1.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	040	0	1	01	01	H1036_040_0	3	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								60.00		180.00					55.00		165.00											60.00		180.00				55.00		155.00				60.00				60.00			2	1.83		2	1.83	1.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	040	0	1	01	01	H1036_040_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	040	0	1	01	01	H1036_040_0	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	044	0	1	01	01	H1036_044_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	044	0	1	01	01	H1036_044_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1036	044	0	1	01	01	H1036_044_0	4	Generic	4	010001	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0		0.17	0	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	044	0	1	01	01	H1036_044_0	4	Generic	4	010001	3	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0		0.17	0	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1036	044	0	1	01	01	H1036_044_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	044	0	1	01	01	H1036_044_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	044	0	1	01	01	H1036_044_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								90.00		270.00					85.00		255.00											90.00		270.00				85.00		245.00				90.00				90.00			3	2.83		3	2.83	2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	044	0	1	01	01	H1036_044_0	4	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								90.00		270.00					85.00		255.00											90.00		270.00				85.00		245.00				90.00				90.00			3	2.83		3	2.83	2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	044	0	1	01	01	H1036_044_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	044	0	1	01	01	H1036_044_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	052	0	1	01	01	H1036_052_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	052	0	1	01	01	H1036_052_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1036	052	0	1	01	01	H1036_052_0	3	Generic	4	010001	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0		0.17	0	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	052	0	1	01	01	H1036_052_0	3	Generic	4	010001	3	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0		0.17	0	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1036	052	0	1	01	01	H1036_052_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		35.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	052	0	1	01	01	H1036_052_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		35.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	052	0	1	01	01	H1036_052_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								65.00		195.00					60.00		180.00											65.00		195.00				60.00		170.00				65.00				65.00			2.17	2		2.17	2	2.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	052	0	1	01	01	H1036_052_0	3	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								65.00		195.00					60.00		180.00											65.00		195.00				60.00		170.00				65.00				65.00			2.17	2		2.17	2	2.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	052	0	1	01	01	H1036_052_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	052	0	1	01	01	H1036_052_0	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	054	0	1	01	01	H1036_054_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	054	0	1	01	01	H1036_054_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1036	054	0	1	01	01	H1036_054_0	3	Generic	4	010001	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0		0.17	0	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	054	0	1	01	01	H1036_054_0	3	Generic	4	010001	3	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0		0.17	0	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1036	054	0	1	01	01	H1036_054_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				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												
H1036	054	0	1	01	01	H1036_054_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				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										2	3	
H1036	054	0	1	01	01	H1036_054_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								50.00		150.00					45.00		135.00											50.00		150.00				45.00		125.00				50.00				50.00			1.67	1.50		1.67	1.50	1.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	054	0	1	01	01	H1036_054_0	3	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								50.00		150.00					45.00		135.00											50.00		150.00				45.00		125.00				50.00				50.00			1.67	1.50		1.67	1.50	1.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	054	0	1	01	01	H1036_054_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	054	0	1	01	01	H1036_054_0	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	062	0	1	01	01	H1036_062_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	062	0	1	01	01	H1036_062_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1036	062	0	1	01	01	H1036_062_0	3	Generic	4	010001	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	062	0	1	01	01	H1036_062_0	3	Generic	4	010001	3	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1036	062	0	1	01	01	H1036_062_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	062	0	1	01	01	H1036_062_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	062	0	1	01	01	H1036_062_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	062	0	1	01	01	H1036_062_0	3	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	062	0	1	01	01	H1036_062_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	062	0	1	01	01	H1036_062_0	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	065	0	1	01	01	H1036_065_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0		0.17	0	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	065	0	1	01	01	H1036_065_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0		0.17	0	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1036	065	0	1	01	01	H1036_065_0	3	Generic	4	010001	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	065	0	1	01	01	H1036_065_0	3	Generic	4	010001	3	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1036	065	0	1	01	01	H1036_065_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					20.00		60.00											47.00		141.00				20.00		50.00				47.00				47.00			1.57	0.67		1.57	0.67	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	065	0	1	01	01	H1036_065_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					20.00		60.00											47.00		141.00				20.00		50.00				47.00				47.00			1.57	0.67		1.57	0.67	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	065	0	1	01	01	H1036_065_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					85.00		255.00											100.00		300.00				85.00		245.00				100.00				100.00			3.33	2.83		3.33	2.83	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	065	0	1	01	01	H1036_065_0	3	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					85.00		255.00											100.00		300.00				85.00		245.00				100.00				100.00			3.33	2.83		3.33	2.83	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	065	0	1	01	01	H1036_065_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	065	0	1	01	01	H1036_065_0	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	067	0	1	01	01	H1036_067_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	067	0	1	01	01	H1036_067_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1036	067	0	1	01	01	H1036_067_0	3	Generic	4	010001	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0		0.17	0	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	067	0	1	01	01	H1036_067_0	3	Generic	4	010001	3	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0		0.17	0	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1036	067	0	1	01	01	H1036_067_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								15.00		45.00					10.00		30.00											15.00		45.00				10.00		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												
H1036	067	0	1	01	01	H1036_067_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								15.00		45.00					10.00		30.00											15.00		45.00				10.00		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										2	3	
H1036	067	0	1	01	01	H1036_067_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								60.00		180.00					55.00		165.00											60.00		180.00				55.00		155.00				60.00				60.00			2	1.83		2	1.83	1.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	067	0	1	01	01	H1036_067_0	3	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								60.00		180.00					55.00		165.00											60.00		180.00				55.00		155.00				60.00				60.00			2	1.83		2	1.83	1.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	067	0	1	01	01	H1036_067_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	067	0	1	01	01	H1036_067_0	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	068	0	1	01	01	H1036_068_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0		0.17	0	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	068	0	1	01	01	H1036_068_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0		0.17	0	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1036	068	0	1	01	01	H1036_068_0	3	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								15.00		45.00					10.00		30.00											15.00		45.00				10.00		0.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	068	0	1	01	01	H1036_068_0	3	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								15.00		45.00					10.00		30.00											15.00		45.00				10.00		0.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1036	068	0	1	01	01	H1036_068_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								45.00		135.00					40.00		120.00											45.00		135.00				40.00		110.00				45.00				45.00			1.50	1.33		1.50	1.33	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	068	0	1	01	01	H1036_068_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								45.00		135.00					40.00		120.00											45.00		135.00				40.00		110.00				45.00				45.00			1.50	1.33		1.50	1.33	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	068	0	1	01	01	H1036_068_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								94.00		282.00					89.00		267.00											94.00		282.00				89.00		257.00				94.00				94.00			3.13	2.97		3.13	2.97	3.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	068	0	1	01	01	H1036_068_0	3	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								94.00		282.00					89.00		267.00											94.00		282.00				89.00		257.00				94.00				94.00			3.13	2.97		3.13	2.97	3.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	068	0	1	01	01	H1036_068_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	068	0	1	01	01	H1036_068_0	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	074	0	1	01	01	H1036_074_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	074	0	1	01	01	H1036_074_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1036	074	0	1	01	01	H1036_074_0	3	Generic	4	010001	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0		0.17	0	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	074	0	1	01	01	H1036_074_0	3	Generic	4	010001	3	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0		0.17	0	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1036	074	0	1	01	01	H1036_074_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		35.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	074	0	1	01	01	H1036_074_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		35.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	074	0	1	01	01	H1036_074_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								65.00		195.00					60.00		180.00											65.00		195.00				60.00		170.00				65.00				65.00			2.17	2		2.17	2	2.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	074	0	1	01	01	H1036_074_0	3	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								65.00		195.00					60.00		180.00											65.00		195.00				60.00		170.00				65.00				65.00			2.17	2		2.17	2	2.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	074	0	1	01	01	H1036_074_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	074	0	1	01	01	H1036_074_0	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	077	0	1	01	01	H1036_077_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	077	0	1	01	01	H1036_077_0	4	Generic	4	010001	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				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	077	0	1	01	01	H1036_077_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	077	0	1	01	01	H1036_077_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	077	0	1	01	01	H1036_077_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	081	0	1	01	01	H1036_081_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0		0.17	0	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	081	0	1	01	01	H1036_081_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0		0.17	0	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1036	081	0	1	01	01	H1036_081_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								15.00		45.00					10.00		30.00											15.00		45.00				10.00		0.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	081	0	1	01	01	H1036_081_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								9.00		27.00					4.00		12.00											9.00		27.00				4.00		0.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1036	081	0	1	01	01	H1036_081_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	081	0	1	01	01	H1036_081_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	081	0	1	01	01	H1036_081_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								94.00		282.00					89.00		267.00											94.00		282.00				89.00		257.00				94.00				94.00			3.13	2.97		3.13	2.97	3.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	081	0	1	01	01	H1036_081_0	4	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								94.00		282.00					89.00		267.00											94.00		282.00				89.00		257.00				94.00				94.00			3.13	2.97		3.13	2.97	3.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	081	0	1	01	01	H1036_081_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	081	0	1	01	01	H1036_081_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	102	0	1	01	01	H1036_102_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	102	0	1	01	01	H1036_102_0	3	Generic	4	010001	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	102	0	1	01	01	H1036_102_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	102	0	1	01	01	H1036_102_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	102	0	1	01	01	H1036_102_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	103	0	1	01	01	H1036_103_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	103	0	1	01	01	H1036_103_0	4	Generic	4	010001	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				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	103	0	1	01	01	H1036_103_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	103	0	1	01	01	H1036_103_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	103	0	1	01	01	H1036_103_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	104	0	1	01	01	H1036_104_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	104	0	1	01	01	H1036_104_0	3	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	104	0	1	01	01	H1036_104_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	104	0	1	01	01	H1036_104_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	104	0	1	01	01	H1036_104_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	121	0	1	01	01	H1036_121_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	121	0	1	01	01	H1036_121_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1036	121	0	1	01	01	H1036_121_0	3	Generic	4	010001	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	121	0	1	01	01	H1036_121_0	3	Generic	4	010001	3	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1036	121	0	1	01	01	H1036_121_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								45.00		135.00					40.00		120.00											45.00		135.00				40.00		110.00				45.00				45.00			1.50	1.33		1.50	1.33	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	121	0	1	01	01	H1036_121_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								45.00		135.00					40.00		120.00											45.00		135.00				40.00		110.00				45.00				45.00			1.50	1.33		1.50	1.33	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	121	0	1	01	01	H1036_121_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								90.00		270.00					85.00		255.00											90.00		270.00				85.00		245.00				90.00				90.00			3	2.83		3	2.83	2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	121	0	1	01	01	H1036_121_0	3	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								90.00		270.00					85.00		255.00											90.00		270.00				85.00		245.00				90.00				90.00			3	2.83		3	2.83	2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	121	0	1	01	01	H1036_121_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	121	0	1	01	01	H1036_121_0	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	130	0	1	01	01	H1036_130_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	130	0	1	01	01	H1036_130_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1036	130	0	1	01	01	H1036_130_0	3	Generic	4	010001	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	130	0	1	01	01	H1036_130_0	3	Generic	4	010001	3	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1036	130	0	1	01	01	H1036_130_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	130	0	1	01	01	H1036_130_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	130	0	1	01	01	H1036_130_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	130	0	1	01	01	H1036_130_0	3	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	130	0	1	01	01	H1036_130_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	130	0	1	01	01	H1036_130_0	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	137	0	1	01	01	H1036_137_0	5	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	137	0	1	01	01	H1036_137_0	5	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	137	0	1	01	01	H1036_137_0	5	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	137	0	1	01	01	H1036_137_0	5	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	137	0	1	01	01	H1036_137_0	5	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	137	0	1	01	01	H1036_137_0	5	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	137	0	1	01	01	H1036_137_0	5	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	137	0	1	01	01	H1036_137_0	5	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	137	0	1	01	01	H1036_137_0	5	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	137	0	1	01	01	H1036_137_0	5	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	138	0	1	01	01	H1036_138_0	5	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	138	0	1	01	01	H1036_138_0	5	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	138	0	1	01	01	H1036_138_0	5	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	138	0	1	01	01	H1036_138_0	5	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	138	0	1	01	01	H1036_138_0	5	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	138	0	1	01	01	H1036_138_0	5	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	138	0	1	01	01	H1036_138_0	5	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	138	0	1	01	01	H1036_138_0	5	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	138	0	1	01	01	H1036_138_0	5	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	138	0	1	01	01	H1036_138_0	5	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	140	0	1	01	01	H1036_140_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	140	0	1	01	01	H1036_140_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	140	0	1	01	01	H1036_140_0	3	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								15.00		45.00					10.00		30.00											15.00		45.00				10.00		0.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	140	0	1	01	01	H1036_140_0	3	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								15.00		45.00					10.00		30.00											15.00		45.00				10.00		0.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	140	0	1	01	01	H1036_140_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	140	0	1	01	01	H1036_140_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	140	0	1	01	01	H1036_140_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								80.00		240.00					75.00		225.00											80.00		240.00				75.00		215.00				80.00				80.00			2.67	2.50		2.67	2.50	2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	140	0	1	01	01	H1036_140_0	3	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								80.00		240.00					75.00		225.00											80.00		240.00				75.00		215.00				80.00				80.00			2.67	2.50		2.67	2.50	2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	140	0	1	01	01	H1036_140_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	140	0	1	01	01	H1036_140_0	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	141	0	1	01	01	H1036_141_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	141	0	1	01	01	H1036_141_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	141	0	1	01	01	H1036_141_0	3	Generic	4	010001	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								15.00		45.00					10.00		30.00											15.00		45.00				10.00		0.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	141	0	1	01	01	H1036_141_0	3	Generic	4	010001	3	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								15.00		45.00					10.00		30.00											15.00		45.00				10.00		0.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	3
H1036	141	0	1	01	01	H1036_141_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	141	0	1	01	01	H1036_141_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	141	0	1	01	01	H1036_141_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	141	0	1	01	01	H1036_141_0	3	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	141	0	1	01	01	H1036_141_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	141	0	1	01	01	H1036_141_0	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	143	0	1	01	01	H1036_143_0	7	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0		0.17	0	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	143	0	1	01	01	H1036_143_0	7	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0		0.17	0	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	143	0	1	01	01	H1036_143_0	7	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					10.00		30.00											10.00		30.00				10.00		0.00				10.00				10.00			0.33	0.33		0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	143	0	1	01	01	H1036_143_0	7	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								13.00		39.00					8.00		24.00											13.00		39.00				8.00		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										2	3	
H1036	143	0	1	01	01	H1036_143_0	7	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	143	0	1	01	01	H1036_143_0	7	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	143	0	1	01	01	H1036_143_0	7	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								90.00		270.00					85.00		255.00											90.00		270.00				85.00		245.00				90.00				90.00			3	2.83		3	2.83	2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	143	0	1	01	01	H1036_143_0	7	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								90.00		270.00					85.00		255.00											90.00		270.00				85.00		245.00				90.00				90.00			3	2.83		3	2.83	2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	143	0	1	01	01	H1036_143_0	7	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	143	0	1	01	01	H1036_143_0	7	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	146	0	1	01	01	H1036_146_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								7.00		21.00					0.00		0.00											7.00		21.00				0.00		0.00				7.00				7.00			0.23	0		0.23	0	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	146	0	1	01	01	H1036_146_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								7.00		21.00					0.00		0.00											7.00		21.00				0.00		0.00				7.00				7.00			0.23	0		0.23	0	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1036	146	0	1	01	01	H1036_146_0	3	Generic	4	010001	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								15.00		45.00					10.00		30.00											15.00		45.00				10.00		0.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	146	0	1	01	01	H1036_146_0	3	Generic	4	010001	3	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								15.00		45.00					10.00		30.00											15.00		45.00				10.00		0.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1036	146	0	1	01	01	H1036_146_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								40.00		120.00					35.00		105.00											40.00		120.00				35.00		95.00				40.00				40.00			1.33	1.17		1.33	1.17	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	146	0	1	01	01	H1036_146_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								40.00		120.00					35.00		105.00											40.00		120.00				35.00		95.00				40.00				40.00			1.33	1.17		1.33	1.17	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	146	0	1	01	01	H1036_146_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								90.00		270.00					85.00		255.00											90.00		270.00				85.00		245.00				90.00				90.00			3	2.83		3	2.83	2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	146	0	1	01	01	H1036_146_0	3	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								90.00		270.00					85.00		255.00											90.00		270.00				85.00		245.00				90.00				90.00			3	2.83		3	2.83	2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	146	0	1	01	01	H1036_146_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	146	0	1	01	01	H1036_146_0	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	151	0	1	01	01	H1036_151_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	151	0	1	01	01	H1036_151_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	151	0	1	01	01	H1036_151_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	151	0	1	01	01	H1036_151_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	151	0	1	01	01	H1036_151_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	151	0	1	01	01	H1036_151_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	151	0	1	01	01	H1036_151_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	151	0	1	01	01	H1036_151_0	4	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	151	0	1	01	01	H1036_151_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	151	0	1	01	01	H1036_151_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	153	0	1	01	01	H1036_153_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								8.00		24.00					3.00		9.00											8.00		24.00				3.00		0.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	153	0	1	01	01	H1036_153_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								8.00		24.00					3.00		9.00											8.00		24.00				3.00		0.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	153	0	1	01	01	H1036_153_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	153	0	1	01	01	H1036_153_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	153	0	1	01	01	H1036_153_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	153	0	1	01	01	H1036_153_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	153	0	1	01	01	H1036_153_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	153	0	1	01	01	H1036_153_0	4	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	153	0	1	01	01	H1036_153_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	153	0	1	01	01	H1036_153_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	156	0	1	01	01	H1036_156_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	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	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H1036	156	0	1	01	01	H1036_156_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	156	0	1	01	01	H1036_156_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H1036	156	0	1	01	01	H1036_156_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	156	0	1	01	01	H1036_156_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H1036	156	0	1	01	01	H1036_156_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								90.00		270.00					85.00		255.00											90.00		270.00				85.00		245.00				90.00				90.00			3	2.83		3	2.83	2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	156	0	1	01	01	H1036_156_0	4	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								90.00		270.00					85.00		255.00											90.00		270.00				85.00		245.00				90.00				90.00			3	2.83		3	2.83	2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H1036	156	0	1	01	01	H1036_156_0	4	Specialty Tier	4	010010	1	1	5	1		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												
H1036	156	0	1	01	01	H1036_156_0	4	Specialty Tier	4	010010	1	1	5	3		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										2	3	
H1036	156	0	1	01	01	H1036_156_0	4	Select Care Drugs	4	010010	1	2	6	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	156	0	1	01	01	H1036_156_0	4	Select Care Drugs	4	010010	1	2	6	3		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1036	157	0	1	01	01	H1036_157_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	157	0	1	01	01	H1036_157_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	157	0	1	01	01	H1036_157_0	3	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	157	0	1	01	01	H1036_157_0	3	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	157	0	1	01	01	H1036_157_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	157	0	1	01	01	H1036_157_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	157	0	1	01	01	H1036_157_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	157	0	1	01	01	H1036_157_0	3	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	157	0	1	01	01	H1036_157_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	157	0	1	01	01	H1036_157_0	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	160	0	1	01	01	H1036_160_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	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	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	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	Generic	4	010001	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0		0.17	0	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	160	0	1	01	01	H1036_160_0	3	Generic	4	010001	3	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0		0.17	0	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	3
H1036	160	0	1	01	01	H1036_160_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		35.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	160	0	1	01	01	H1036_160_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		35.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H1036	160	0	1	01	01	H1036_160_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								65.00		195.00					60.00		180.00											65.00		195.00				60.00		170.00				65.00				65.00			2.17	2		2.17	2	2.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	160	0	1	01	01	H1036_160_0	3	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								65.00		195.00					60.00		180.00											65.00		195.00				60.00		170.00				65.00				65.00			2.17	2		2.17	2	2.10	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	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	160	0	1	01	01	H1036_160_0	3	Specialty Tier	4	010010	1	1	5	3		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										2	3	
H1036	160	0	1	01	01	H1036_160_0	3	Select Care Drugs	4	010010	1	2	6	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	160	0	1	01	01	H1036_160_0	3	Select Care Drugs	4	010010	1	2	6	3		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1036	167	0	1	01	01	H1036_167_0	5	Preferred Generic	3	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	167	0	1	01	01	H1036_167_0	5	Generic	3	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								16.00		48.00					11.00		33.00											16.00		48.00				11.00		0.00				16.00				16.00			0.53	0.37		0.53	0.37	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	167	0	1	01	01	H1036_167_0	5	Preferred Brand	3	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	167	0	1	01	01	H1036_167_0	5	Non-Preferred Drug	3	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	167	0	1	01	01	H1036_167_0	5	Specialty Tier	3	010010	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	168	0	1	01	01	H1036_168_0	5	Preferred Generic	3	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	168	0	1	01	01	H1036_168_0	5	Generic	3	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								17.00		51.00					12.00		36.00											17.00		51.00				12.00		0.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	168	0	1	01	01	H1036_168_0	5	Preferred Brand	3	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	168	0	1	01	01	H1036_168_0	5	Non-Preferred Drug	3	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	168	0	1	01	01	H1036_168_0	5	Specialty Tier	3	010010	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	171	0	1	01	01	H1036_171_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	171	0	1	01	01	H1036_171_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	171	0	1	01	01	H1036_171_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	171	0	1	01	01	H1036_171_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	171	0	1	01	01	H1036_171_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	171	0	1	01	01	H1036_171_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	171	0	1	01	01	H1036_171_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	171	0	1	01	01	H1036_171_0	4	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	171	0	1	01	01	H1036_171_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	171	0	1	01	01	H1036_171_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	175	0	1	01	01	H1036_175_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0		0.17	0	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	175	0	1	01	01	H1036_175_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0		0.17	0	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H1036	175	0	1	01	01	H1036_175_0	3	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								15.00		45.00					10.00		30.00											15.00		45.00				10.00		0.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	175	0	1	01	01	H1036_175_0	3	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								15.00		45.00					10.00		30.00											15.00		45.00				10.00		0.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H1036	175	0	1	01	01	H1036_175_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	175	0	1	01	01	H1036_175_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H1036	175	0	1	01	01	H1036_175_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								94.00		282.00					89.00		267.00											94.00		282.00				89.00		257.00				94.00				94.00			3.13	2.97		3.13	2.97	3.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	175	0	1	01	01	H1036_175_0	3	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								94.00		282.00					89.00		267.00											94.00		282.00				89.00		257.00				94.00				94.00			3.13	2.97		3.13	2.97	3.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H1036	175	0	1	01	01	H1036_175_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	175	0	1	01	01	H1036_175_0	3	Specialty Tier	4	010010	1	1	5	3		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										2	3	
H1036	175	0	1	01	01	H1036_175_0	3	Select Care Drugs	4	010010	1	2	6	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	175	0	1	01	01	H1036_175_0	3	Select Care Drugs	4	010010	1	2	6	3		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1036	196	0	1	01	01	H1036_196_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								7.00		21.00					0.00		0.00											7.00		21.00				0.00		0.00				7.00				7.00			0.23	0		0.23	0	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	196	0	1	01	01	H1036_196_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								7.00		21.00					0.00		0.00											7.00		21.00				0.00		0.00				7.00				7.00			0.23	0		0.23	0	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	196	0	1	01	01	H1036_196_0	3	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	196	0	1	01	01	H1036_196_0	3	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	196	0	1	01	01	H1036_196_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	196	0	1	01	01	H1036_196_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	196	0	1	01	01	H1036_196_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	196	0	1	01	01	H1036_196_0	3	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	196	0	1	01	01	H1036_196_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	196	0	1	01	01	H1036_196_0	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	199	0	1	01	01	H1036_199_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	199	0	1	01	01	H1036_199_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	199	0	1	01	01	H1036_199_0	3	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	199	0	1	01	01	H1036_199_0	3	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	199	0	1	01	01	H1036_199_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	199	0	1	01	01	H1036_199_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	199	0	1	01	01	H1036_199_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	199	0	1	01	01	H1036_199_0	3	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	199	0	1	01	01	H1036_199_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	199	0	1	01	01	H1036_199_0	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	209	0	1	01	01	H1036_209_0	4	Preferred Generic	3	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	209	0	1	01	01	H1036_209_0	4	Generic	3	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	209	0	1	01	01	H1036_209_0	4	Preferred Brand	3	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	209	0	1	01	01	H1036_209_0	4	Non-Preferred Drug	3	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	209	0	1	01	01	H1036_209_0	4	Specialty Tier	3	010010	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	210	0	1	01	01	H1036_210_0	4	Preferred Generic	3	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	210	0	1	01	01	H1036_210_0	4	Generic	3	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								11.00		33.00					6.00		18.00											11.00		33.00				6.00		0.00				11.00				11.00			0.37	0.20		0.37	0.20	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	210	0	1	01	01	H1036_210_0	4	Preferred Brand	3	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	210	0	1	01	01	H1036_210_0	4	Non-Preferred Drug	3	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	210	0	1	01	01	H1036_210_0	4	Specialty Tier	3	010010	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	213	0	1	01	01	H1036_213_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	213	0	1	01	01	H1036_213_0	3	Generic	4	010001	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								9.00		27.00					4.00		12.00											9.00		27.00				4.00		0.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	213	0	1	01	01	H1036_213_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	213	0	1	01	01	H1036_213_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	213	0	1	01	01	H1036_213_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	214	0	1	01	01	H1036_214_0	4	Preferred Generic	3	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	214	0	1	01	01	H1036_214_0	4	Generic	3	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								9.00		27.00					4.00		12.00											9.00		27.00				4.00		0.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	214	0	1	01	01	H1036_214_0	4	Preferred Brand	3	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	214	0	1	01	01	H1036_214_0	4	Non-Preferred Drug	3	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	214	0	1	01	01	H1036_214_0	4	Specialty Tier	3	010010	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	215	0	1	01	01	H1036_215_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0		0.17	0	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	215	0	1	01	01	H1036_215_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0		0.17	0	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	215	0	1	01	01	H1036_215_0	3	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	215	0	1	01	01	H1036_215_0	3	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	215	0	1	01	01	H1036_215_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	215	0	1	01	01	H1036_215_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	215	0	1	01	01	H1036_215_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	215	0	1	01	01	H1036_215_0	3	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	215	0	1	01	01	H1036_215_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	215	0	1	01	01	H1036_215_0	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	217	0	1	01	01	H1036_217_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								7.00		21.00					0.00		0.00											7.00		21.00				0.00		0.00				7.00				7.00			0.23	0		0.23	0	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	217	0	1	01	01	H1036_217_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								7.00		21.00					0.00		0.00											7.00		21.00				0.00		0.00				7.00				7.00			0.23	0		0.23	0	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	217	0	1	01	01	H1036_217_0	3	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	217	0	1	01	01	H1036_217_0	3	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	217	0	1	01	01	H1036_217_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	217	0	1	01	01	H1036_217_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	217	0	1	01	01	H1036_217_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	217	0	1	01	01	H1036_217_0	3	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	217	0	1	01	01	H1036_217_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	217	0	1	01	01	H1036_217_0	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	218	0	1	01	01	H1036_218_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								7.00		21.00					0.00		0.00											7.00		21.00				0.00		0.00				7.00				7.00			0.23	0		0.23	0	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	218	0	1	01	01	H1036_218_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								7.00		21.00					0.00		0.00											7.00		21.00				0.00		0.00				7.00				7.00			0.23	0		0.23	0	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	218	0	1	01	01	H1036_218_0	3	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	218	0	1	01	01	H1036_218_0	3	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	218	0	1	01	01	H1036_218_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	218	0	1	01	01	H1036_218_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	218	0	1	01	01	H1036_218_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	218	0	1	01	01	H1036_218_0	3	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	218	0	1	01	01	H1036_218_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	218	0	1	01	01	H1036_218_0	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	219	0	1	01	01	H1036_219_0	5	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	219	0	1	01	01	H1036_219_0	5	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	219	0	1	01	01	H1036_219_0	5	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	219	0	1	01	01	H1036_219_0	5	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	219	0	1	01	01	H1036_219_0	5	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	219	0	1	01	01	H1036_219_0	5	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	219	0	1	01	01	H1036_219_0	5	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	219	0	1	01	01	H1036_219_0	5	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	219	0	1	01	01	H1036_219_0	5	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	219	0	1	01	01	H1036_219_0	5	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	222	0	1	01	01	H1036_222_0	4	Preferred Generic	3	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	222	0	1	01	01	H1036_222_0	4	Generic	3	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								14.00		42.00					9.00		27.00											14.00		42.00				9.00		0.00				14.00				14.00			0.47	0.30		0.47	0.30	0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	222	0	1	01	01	H1036_222_0	4	Preferred Brand	3	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	222	0	1	01	01	H1036_222_0	4	Non-Preferred Drug	3	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	222	0	1	01	01	H1036_222_0	4	Specialty Tier	3	010010	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	223	0	1	01	01	H1036_223_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	223	0	1	01	01	H1036_223_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	223	0	1	01	01	H1036_223_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	223	0	1	01	01	H1036_223_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	223	0	1	01	01	H1036_223_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	223	0	1	01	01	H1036_223_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	223	0	1	01	01	H1036_223_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	223	0	1	01	01	H1036_223_0	4	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	223	0	1	01	01	H1036_223_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	223	0	1	01	01	H1036_223_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	226	0	1	01	01	H1036_226_0	3	Preferred Generic	3	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	226	0	1	01	01	H1036_226_0	3	Generic	3	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								9.00		27.00					4.00		12.00											9.00		27.00				4.00		0.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	226	0	1	01	01	H1036_226_0	3	Preferred Brand	3	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	226	0	1	01	01	H1036_226_0	3	Non-Preferred Drug	3	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	226	0	1	01	01	H1036_226_0	3	Specialty Tier	3	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	229	0	1	01	01	H1036_229_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	229	0	1	01	01	H1036_229_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	229	0	1	01	01	H1036_229_0	3	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	229	0	1	01	01	H1036_229_0	3	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	229	0	1	01	01	H1036_229_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	229	0	1	01	01	H1036_229_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	229	0	1	01	01	H1036_229_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	229	0	1	01	01	H1036_229_0	3	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	229	0	1	01	01	H1036_229_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	229	0	1	01	01	H1036_229_0	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	230	0	1	01	01	H1036_230_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	230	0	1	01	01	H1036_230_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	230	0	1	01	01	H1036_230_0	3	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	230	0	1	01	01	H1036_230_0	3	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	230	0	1	01	01	H1036_230_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	230	0	1	01	01	H1036_230_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	230	0	1	01	01	H1036_230_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	230	0	1	01	01	H1036_230_0	3	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	230	0	1	01	01	H1036_230_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	230	0	1	01	01	H1036_230_0	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	231	0	1	01	01	H1036_231_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	231	0	1	01	01	H1036_231_0	3	Generic	4	010001	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								6.00		18.00					1.00		3.00											6.00		18.00				1.00		0.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	231	0	1	01	01	H1036_231_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	231	0	1	01	01	H1036_231_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	231	0	1	01	01	H1036_231_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	233	0	1	01	01	H1036_233_0	5	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	233	0	1	01	01	H1036_233_0	5	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	233	0	1	01	01	H1036_233_0	5	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	233	0	1	01	01	H1036_233_0	5	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	233	0	1	01	01	H1036_233_0	5	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	233	0	1	01	01	H1036_233_0	5	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	233	0	1	01	01	H1036_233_0	5	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	233	0	1	01	01	H1036_233_0	5	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	233	0	1	01	01	H1036_233_0	5	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	233	0	1	01	01	H1036_233_0	5	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	234	0	1	01	01	H1036_234_0	5	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	234	0	1	01	01	H1036_234_0	5	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H1036	234	0	1	01	01	H1036_234_0	5	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								19.00		57.00					14.00		42.00											19.00		57.00				14.00		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												
H1036	234	0	1	01	01	H1036_234_0	5	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								19.00		57.00					14.00		42.00											19.00		57.00				14.00		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										2	3	
H1036	234	0	1	01	01	H1036_234_0	5	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	234	0	1	01	01	H1036_234_0	5	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H1036	234	0	1	01	01	H1036_234_0	5	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	234	0	1	01	01	H1036_234_0	5	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				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										2	3	
H1036	234	0	1	01	01	H1036_234_0	5	Specialty Tier	4	010010	1	1	5	1		010	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												
H1036	234	0	1	01	01	H1036_234_0	5	Specialty Tier	4	010010	1	1	5	3		010	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										2	3	
H1036	234	0	1	01	01	H1036_234_0	5	Select Care Drugs	4	010010	1	2	6	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1036	235	0	1	01	01	H1036_235_0	6	Preferred Generic	3	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	235	0	1	01	01	H1036_235_0	6	Generic	3	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					19.00		57.00											20.00		60.00				19.00		0.00				20.00				20.00			0.67	0.63		0.67	0.63	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	235	0	1	01	01	H1036_235_0	6	Preferred Brand	3	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	235	0	1	01	01	H1036_235_0	6	Non-Preferred Drug	3	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	235	0	1	01	01	H1036_235_0	6	Specialty Tier	3	010010	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	236	0	1	01	01	H1036_236_0	5	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	236	0	1	01	01	H1036_236_0	5	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	236	0	1	01	01	H1036_236_0	5	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								19.00		57.00					14.00		42.00											19.00		57.00				14.00		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												
H1036	236	0	1	01	01	H1036_236_0	5	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								19.00		57.00					14.00		42.00											19.00		57.00				14.00		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										2	3	
H1036	236	0	1	01	01	H1036_236_0	5	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	236	0	1	01	01	H1036_236_0	5	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	236	0	1	01	01	H1036_236_0	5	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	236	0	1	01	01	H1036_236_0	5	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	236	0	1	01	01	H1036_236_0	5	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	236	0	1	01	01	H1036_236_0	5	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	237	1	1	01	01	H1036_237_1	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0		0.17	0	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	237	1	1	01	01	H1036_237_1	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0		0.17	0	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	237	1	1	01	01	H1036_237_1	3	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	237	1	1	01	01	H1036_237_1	3	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	237	1	1	01	01	H1036_237_1	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	237	1	1	01	01	H1036_237_1	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	237	1	1	01	01	H1036_237_1	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	237	1	1	01	01	H1036_237_1	3	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	237	1	1	01	01	H1036_237_1	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	237	1	1	01	01	H1036_237_1	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	237	2	1	01	01	H1036_237_2	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0		0.17	0	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	237	2	1	01	01	H1036_237_2	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0		0.17	0	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	237	2	1	01	01	H1036_237_2	3	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	237	2	1	01	01	H1036_237_2	3	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	237	2	1	01	01	H1036_237_2	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	237	2	1	01	01	H1036_237_2	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	237	2	1	01	01	H1036_237_2	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	237	2	1	01	01	H1036_237_2	3	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	237	2	1	01	01	H1036_237_2	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	237	2	1	01	01	H1036_237_2	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1036	241	0	1	01	01	H1036_241_0	4	Preferred Generic	3	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	241	0	1	01	01	H1036_241_0	4	Generic	3	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								15.00		45.00					10.00		30.00											15.00		45.00				10.00		0.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	241	0	1	01	01	H1036_241_0	4	Preferred Brand	3	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	241	0	1	01	01	H1036_241_0	4	Non-Preferred Drug	3	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	241	0	1	01	01	H1036_241_0	4	Specialty Tier	3	010010	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	243	0	1	01	01	H1036_243_0	4	Preferred Generic	3	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	243	0	1	01	01	H1036_243_0	4	Generic	3	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								14.00		42.00					9.00		27.00											14.00		42.00				9.00		0.00				14.00				14.00			0.47	0.30		0.47	0.30	0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	243	0	1	01	01	H1036_243_0	4	Preferred Brand	3	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	243	0	1	01	01	H1036_243_0	4	Non-Preferred Drug	3	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	243	0	1	01	01	H1036_243_0	4	Specialty Tier	3	010010	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	245	0	1	01	01	H1036_245_0	3	Preferred Generic	3	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	245	0	1	01	01	H1036_245_0	3	Generic	3	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	245	0	1	01	01	H1036_245_0	3	Preferred Brand	3	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	245	0	1	01	01	H1036_245_0	3	Non-Preferred Drug	3	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	245	0	1	01	01	H1036_245_0	3	Specialty Tier	3	010010	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	247	0	1	01	01	H1036_247_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	247	0	1	01	01	H1036_247_0	3	Generic	4	010001	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								9.00		27.00					4.00		12.00											9.00		27.00				4.00		0.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	247	0	1	01	01	H1036_247_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	247	0	1	01	01	H1036_247_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	247	0	1	01	01	H1036_247_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	249	0	1	01	01	H1036_249_0	3	Preferred Generic	3	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	249	0	1	01	01	H1036_249_0	3	Generic	3	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								8.00		24.00					3.00		9.00											8.00		24.00				3.00		0.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	249	0	1	01	01	H1036_249_0	3	Preferred Brand	3	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	249	0	1	01	01	H1036_249_0	3	Non-Preferred Drug	3	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	249	0	1	01	01	H1036_249_0	3	Specialty Tier	3	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	251	0	1	01	01	H1036_251_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	251	0	1	01	01	H1036_251_0	3	Generic	4	010001	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								8.00		24.00					3.00		9.00											8.00		24.00				3.00		0.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	251	0	1	01	01	H1036_251_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	251	0	1	01	01	H1036_251_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	251	0	1	01	01	H1036_251_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	253	0	1	01	01	H1036_253_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	253	0	1	01	01	H1036_253_0	3	Generic	4	010001	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								6.00		18.00					1.00		3.00											6.00		18.00				1.00		0.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	253	0	1	01	01	H1036_253_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	253	0	1	01	01	H1036_253_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	253	0	1	01	01	H1036_253_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	255	0	1	01	01	H1036_255_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	255	0	1	01	01	H1036_255_0	3	Generic	4	010001	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				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	255	0	1	01	01	H1036_255_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	255	0	1	01	01	H1036_255_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	255	0	1	01	01	H1036_255_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	257	0	1	01	01	H1036_257_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	257	0	1	01	01	H1036_257_0	3	Generic	4	010001	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				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	257	0	1	01	01	H1036_257_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	257	0	1	01	01	H1036_257_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	257	0	1	01	01	H1036_257_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	259	0	1	01	01	H1036_259_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	259	0	1	01	01	H1036_259_0	3	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	259	0	1	01	01	H1036_259_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	259	0	1	01	01	H1036_259_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	259	0	1	01	01	H1036_259_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	261	0	1	01	01	H1036_261_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	261	0	1	01	01	H1036_261_0	3	Generic	4	010001	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								7.00		21.00					2.00		6.00											7.00		21.00				2.00		0.00				7.00				7.00			0.23	0.07		0.23	0.07	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	261	0	1	01	01	H1036_261_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	261	0	1	01	01	H1036_261_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	261	0	1	01	01	H1036_261_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	262	0	1	01	01	H1036_262_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	262	0	1	01	01	H1036_262_0	3	Generic	4	010001	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								7.00		21.00					2.00		6.00											7.00		21.00				2.00		0.00				7.00				7.00			0.23	0.07		0.23	0.07	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	262	0	1	01	01	H1036_262_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	262	0	1	01	01	H1036_262_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1036	262	0	1	01	01	H1036_262_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	001	0	1	01	01	H1045_001_0	6	Preferred Generic	4	001000	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	001	0	1	01	01	H1045_001_0	6	Preferred Generic	4	001000	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1045	001	0	1	01	01	H1045_001_0	6	Generic	4	010000	3	2	2	1	110		01		100	1	30		90				1	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	001	0	1	01	01	H1045_001_0	6	Generic	4	010000	3	2	2	3	110		01		100	1	30		90				1	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1045	001	0	1	01	01	H1045_001_0	6	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	001	0	1	01	01	H1045_001_0	6	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	40.00		120.00																											120.00						110.00				40.00				40.00		1.33						1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	001	0	1	01	01	H1045_001_0	6	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				825.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	005	0	1	01	01	H1045_005_0	4	Preferred Generic	4	001000	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	005	0	1	01	01	H1045_005_0	4	Preferred Generic	4	001000	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1045	005	0	1	01	01	H1045_005_0	4	Generic	4	010000	3	2	2	1	110		01		100	1	30		90				1	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	005	0	1	01	01	H1045_005_0	4	Generic	4	010000	3	2	2	3	110		01		100	1	30		90				1	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1045	005	0	1	01	01	H1045_005_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	40.00		120.00																											120.00						110.00				40.00				40.00		1.33						1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	005	0	1	01	01	H1045_005_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	85.00		255.00																											255.00						245.00				85.00				85.00		2.83						2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	005	0	1	01	01	H1045_005_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				768.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	012	0	1	01	01	H1045_012_0	4	Preferred Generic	4	001000	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												
H1045	012	0	1	01	01	H1045_012_0	4	Preferred Generic	4	001000	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1045	012	0	1	01	01	H1045_012_0	4	Generic	4	010000	3	2	2	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	012	0	1	01	01	H1045_012_0	4	Generic	4	010000	3	2	2	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1045	012	0	1	01	01	H1045_012_0	4	Preferred Brand	4	010001	1	1	3	1	110		01	100		1	30		90				1	2			90				30		31				45.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	012	0	1	01	01	H1045_012_0	4	Non-Preferred Drug	4	100100	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				54.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	012	0	1	01	01	H1045_012_0	4	Specialty Tier	4	010010	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31				600.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	018	0	1	01	01	H1045_018_0	4	Preferred Generic	4	001000	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	018	0	1	01	01	H1045_018_0	4	Preferred Generic	4	001000	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1045	018	0	1	01	01	H1045_018_0	4	Generic	4	010000	3	2	2	1	110		01		100	1	30		90				1	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	018	0	1	01	01	H1045_018_0	4	Generic	4	010000	3	2	2	3	110		01		100	1	30		90				1	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1045	018	0	1	01	01	H1045_018_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	15.00		45.00																											45.00						35.00				15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	018	0	1	01	01	H1045_018_0	4	Preferred Brand	4	010001	1	2	3	3	110		01		100	1	30		90				1	2						90	30		31	15.00		45.00																											45.00						35.00				15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1045	018	0	1	01	01	H1045_018_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	45.00		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	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				665.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	025	0	1	01	01	H1045_025_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	025	0	1	01	01	H1045_025_0	4	Generic	4	010000	3	2	2	1	110		01		100	1	30		90				1	2						90	30		31	7.00		21.00																											21.00						0.00				7.00				7.00		0.23						0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	025	0	1	01	01	H1045_025_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	025	0	1	01	01	H1045_025_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	025	0	1	01	01	H1045_025_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				924.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	026	0	1	01	01	H1045_026_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	026	0	1	01	01	H1045_026_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	026	0	1	01	01	H1045_026_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	026	0	1	01	01	H1045_026_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	026	0	1	01	01	H1045_026_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				611.00	27		27																										27						27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	027	0	1	02	01	H1045_027_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	027	0	1	02	01	H1045_027_0	4	Generic	4	010000	3	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	027	0	1	02	01	H1045_027_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	027	0	1	02	01	H1045_027_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	027	0	1	02	01	H1045_027_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				887.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	028	0	1	01	01	H1045_028_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	028	0	1	01	01	H1045_028_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	028	0	1	01	01	H1045_028_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	028	0	1	01	01	H1045_028_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	028	0	1	01	01	H1045_028_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				856.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	030	0	1	01	01	H1045_030_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	030	0	1	01	01	H1045_030_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	9.00		27.00																											27.00						0.00				9.00				9.00		0.30						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	030	0	1	01	01	H1045_030_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	030	0	1	01	01	H1045_030_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	030	0	1	01	01	H1045_030_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				845.00	27		27																										27						27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	031	0	1	02	01	H1045_031_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	031	0	1	02	01	H1045_031_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	031	0	1	02	01	H1045_031_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		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	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		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	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				844.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	032	0	1	02	01	H1045_032_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	032	0	1	02	01	H1045_032_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	032	0	1	02	01	H1045_032_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	032	0	1	02	01	H1045_032_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	032	0	1	02	01	H1045_032_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				787.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	033	0	1	01	01	H1045_033_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	033	0	1	01	01	H1045_033_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	033	0	1	01	01	H1045_033_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	033	0	1	01	01	H1045_033_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	033	0	1	01	01	H1045_033_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				787.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	034	0	1	01	01	H1045_034_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	034	0	1	01	01	H1045_034_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	034	0	1	01	01	H1045_034_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	034	0	1	01	01	H1045_034_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	034	0	1	01	01	H1045_034_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				786.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	035	0	1	01	01	H1045_035_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	035	0	1	01	01	H1045_035_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	035	0	1	01	01	H1045_035_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		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	035	0	1	01	01	H1045_035_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		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	035	0	1	01	01	H1045_035_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				787.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	036	0	1	01	01	H1045_036_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	036	0	1	01	01	H1045_036_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	036	0	1	01	01	H1045_036_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	036	0	1	01	01	H1045_036_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	036	0	1	01	01	H1045_036_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				904.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	037	0	1	01	01	H1045_037_0	4	Preferred Generic	4	001000	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	037	0	1	01	01	H1045_037_0	4	Preferred Generic	4	001000	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1045	037	0	1	01	01	H1045_037_0	4	Generic	4	010000	3	2	2	1	110		01		100	1	30		90				1	2						90	30		31	5.00		15.00																											15.00						0.00				5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	037	0	1	01	01	H1045_037_0	4	Generic	4	010000	3	2	2	3	110		01		100	1	30		90				1	2						90	30		31	5.00		15.00																											15.00						0.00				5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1045	037	0	1	01	01	H1045_037_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	40.00		120.00																											120.00						110.00				40.00				40.00		1.33						1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	037	0	1	01	01	H1045_037_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	85.00		255.00																											255.00						245.00				85.00				85.00		2.83						2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	037	0	1	01	01	H1045_037_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				768.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	038	0	1	01	01	H1045_038_0	4	Preferred Generic	4	001000	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												
H1045	038	0	1	01	01	H1045_038_0	4	Preferred Generic	4	001000	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1045	038	0	1	01	01	H1045_038_0	4	Generic	4	010000	3	2	2	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	038	0	1	01	01	H1045_038_0	4	Generic	4	010000	3	2	2	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1045	038	0	1	01	01	H1045_038_0	4	Preferred Brand	4	010001	1	1	3	1	110		01	100		1	30		90				1	2			90				30		31				45.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	038	0	1	01	01	H1045_038_0	4	Non-Preferred Drug	4	100100	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				54.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	038	0	1	01	01	H1045_038_0	4	Specialty Tier	4	010010	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31				601.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	041	0	1	02	01	H1045_041_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	041	0	1	02	01	H1045_041_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	041	0	1	02	01	H1045_041_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		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	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		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	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				786.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	042	0	1	01	01	H1045_042_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	042	0	1	01	01	H1045_042_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	042	0	1	01	01	H1045_042_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	042	0	1	01	01	H1045_042_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	042	0	1	01	01	H1045_042_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				786.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	043	0	1	01	01	H1045_043_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	043	0	1	01	01	H1045_043_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	043	0	1	01	01	H1045_043_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	043	0	1	01	01	H1045_043_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1045	043	0	1	01	01	H1045_043_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				862.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1099	001	0	1	02	01	H1099_001_0	9	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	5.00		15.00																					10.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1099	001	0	1	02	01	H1099_001_0	9	Preferred Generic	4	001000	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	5.00		15.00																					10.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1099	001	0	1	02	01	H1099_001_0	9	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	15.00		45.00																					30.00																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1099	001	0	1	02	01	H1099_001_0	9	Generic	4	010000	1	2	2	3	110		01	100		1	30		90				1	2			90				30		31	15.00		45.00																					30.00																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1099	001	0	1	02	01	H1099_001_0	9	Preferred Brand	4	010001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	45.00		135.00																					112.50																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1099	001	0	1	02	01	H1099_001_0	9	Non-Preferred Drug	4	110000	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	90.00		270.00																					225.00																90.00				90.00		3.00						2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1099	001	0	1	02	01	H1099_001_0	9	Specialty Tier	4	010010	1	1	5	1	010		01			1	30														30		31				1251.84	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1099	001	0	1	02	01	H1099_001_0	9	Select Care Drugs	4	010000	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1099	001	0	1	02	01	H1099_001_0	9	Select Care Drugs	4	010000	1	2	6	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1099	006	0	1	01	01	H1099_006_0	8	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	5.00		15.00																					10.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1099	006	0	1	01	01	H1099_006_0	8	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	15.00		45.00																					30.00																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1099	006	0	1	01	01	H1099_006_0	8	Preferred Brand	4	010001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	45.00		135.00																					112.50																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1099	006	0	1	01	01	H1099_006_0	8	Non-Preferred Drug	4	110000	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	90.00		270.00																					225.00																90.00				90.00		3.00						2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1099	006	0	1	01	01	H1099_006_0	8	Specialty Tier	4	010010	1	1	5	1	010		01			1	30														30		31				1162.35	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1099	006	0	1	01	01	H1099_006_0	8	Select Care Drugs	4	010000	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1099	006	0	1	01	01	H1099_006_0	8	Select Care Drugs	4	010000	1	2	6	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1099	014	0	1	01	01	H1099_014_0	8	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	5.00		15.00																					10.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1099	014	0	1	01	01	H1099_014_0	8	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	15.00		45.00																					30.00																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1099	014	0	1	01	01	H1099_014_0	8	Preferred Brand	4	010001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	45.00		135.00																					112.50																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1099	014	0	1	01	01	H1099_014_0	8	Non-Preferred Drug	4	110000	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	90.00		270.00																					225.00																90.00				90.00		3.00						2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1099	014	0	1	01	01	H1099_014_0	8	Specialty Tier	4	010010	1	1	5	1	010		01			1	30														30		31				1123.48	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1099	014	0	1	01	01	H1099_014_0	8	Select Care Drugs	4	010000	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1099	016	0	1	02	01	H1099_016_0	8	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	2.00		6.00																					0.00																2.00				2.00		0.07						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1099	016	0	1	02	01	H1099_016_0	8	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	5.00		15.00																					0.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1099	016	0	1	02	01	H1099_016_0	8	Preferred Brand	4	010001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	45.00		135.00																					112.50																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1099	016	0	1	02	01	H1099_016_0	8	Non-Preferred Drug	4	110000	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	90.00		270.00																					225.00																90.00				90.00		3.00						2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1099	016	0	1	02	01	H1099_016_0	8	Specialty Tier	4	010010	1	1	5	1	010		01			1	30														30		31				889.89	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1099	016	0	1	02	01	H1099_016_0	8	Select Care Drugs	4	010000	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1099	016	0	1	02	01	H1099_016_0	8	Select Care Drugs	4	010000	1	2	6	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1099	017	0	1	02	01	H1099_017_0	8	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	2.00		6.00																					0.00																2.00				2.00		0.07						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1099	017	0	1	02	01	H1099_017_0	8	Preferred Generic	4	001000	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	2.00		6.00																					0.00																2.00				2.00		0.07						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1099	017	0	1	02	01	H1099_017_0	8	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	5.00		15.00																					0.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1099	017	0	1	02	01	H1099_017_0	8	Generic	4	010000	1	2	2	3	110		01	100		1	30		90				1	2			90				30		31	5.00		15.00																					0.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1099	017	0	1	02	01	H1099_017_0	8	Preferred Brand	4	010001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	45.00		135.00																					112.50																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1099	017	0	1	02	01	H1099_017_0	8	Non-Preferred Drug	4	110000	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	90.00		270.00																					225.00																90.00				90.00		3.00						2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1099	017	0	1	02	01	H1099_017_0	8	Specialty Tier	4	010010	1	1	5	1	010		01			1	30														30		31				978.93	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1099	017	0	1	02	01	H1099_017_0	8	Select Care Drugs	4	010000	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1099	017	0	1	02	01	H1099_017_0	8	Select Care Drugs	4	010000	1	2	6	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1109	005	0	1	01	01	H1109_005_0	5	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1109	005	0	1	01	01	H1109_005_0	5	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1109	005	0	1	01	01	H1109_005_0	5	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1109	005	0	1	01	01	H1109_005_0	5	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1109	005	0	1	01	01	H1109_005_0	5	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	5	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	5	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1111	006	0	1	01	01	H1111_006_0	5	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1111	006	0	1	01	01	H1111_006_0	5	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1111	006	0	1	01	01	H1111_006_0	5	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1111	006	0	1	01	01	H1111_006_0	5	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1111	006	0	1	01	01	H1111_006_0	5	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				768.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1111	007	0	1	01	01	H1111_007_0	5	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1111	007	0	1	01	01	H1111_007_0	5	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1111	007	0	1	01	01	H1111_007_0	5	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1111	007	0	1	01	01	H1111_007_0	5	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1111	007	0	1	01	01	H1111_007_0	5	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				867.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1112	006	0	1	01	01	H1112_006_0	4	Preferred Generic	3	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1112	006	0	1	01	01	H1112_006_0	4	Generic	3	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		42.50				17.00				17.00		0.57				0.57	0.57	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1112	006	0	1	01	01	H1112_006_0	4	Preferred Brand	3	000101	1	2	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												
H1112	006	0	1	01	01	H1112_006_0	4	Non-Preferred Drug	3	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				95.21	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1112	006	0	1	01	01	H1112_006_0	4	Specialty Tier	3	010010	1	1	5	1	010		01		010	1	30											30			30		31				2314.87	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1112	027	0	1	01	01	H1112_027_0	4	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1112	027	0	1	01	01	H1112_027_0	4	Generic	4	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		37.50				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1112	027	0	1	01	01	H1112_027_0	4	Preferred Brand	4	000101	1	2	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												
H1112	027	0	1	01	01	H1112_027_0	4	Non-Preferred Drug	4	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				84.08	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1112	027	0	1	01	01	H1112_027_0	4	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				2452.52	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1112	032	0	1	02	01	H1112_032_0	4	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1112	032	0	1	02	01	H1112_032_0	4	Generic	4	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		12.50				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1112	032	0	1	02	01	H1112_032_0	4	Preferred Brand	4	000101	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	40.00		120.00																									40.00		120.00				40.00		100.00				40.00				40.00		1.33				1.33	1.33	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1112	032	0	1	02	01	H1112_032_0	4	Non-Preferred Drug	4	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				85.65	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1112	032	0	1	02	01	H1112_032_0	4	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				2456.57	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1112	033	0	1	01	01	H1112_033_0	4	Preferred Generic	3	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1112	033	0	1	01	01	H1112_033_0	4	Generic	3	010001	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		35.00				14.00				14.00		0.47				0.47	0.47	0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1112	033	0	1	01	01	H1112_033_0	4	Preferred Brand	3	000101	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		112.50				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1112	033	0	1	01	01	H1112_033_0	4	Non-Preferred Drug	3	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				94.23	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1112	033	0	1	01	01	H1112_033_0	4	Specialty Tier	3	010010	1	1	5	1	010		01		010	1	30											30			30		31				2288.62	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1112	035	0	1	01	01	H1112_035_0	4	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1112	035	0	1	01	01	H1112_035_0	4	Generic	4	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		37.50				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1112	035	0	1	01	01	H1112_035_0	4	Preferred Brand	4	000101	1	2	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												
H1112	035	0	1	01	01	H1112_035_0	4	Non-Preferred Drug	4	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				85.75	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1112	035	0	1	01	01	H1112_035_0	4	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				2456.31	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1170	002	0	1	01	01	H1170_002_0	12	Preferred Generic	4	001000	1	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	5.00		15.00																			5.00		0.00																5.00				5.00		0.16			0.16			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	002	0	1	01	01	H1170_002_0	12	Preferred Generic	4	001000	1	2	1	3	110		01	110		1	30		90				2	2	30		90				30		31	5.00		15.00																			5.00		0.00																5.00				5.00		0.16			0.16			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H1170	002	0	1	01	01	H1170_002_0	12	Generic	4	010000	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 Brand, Specialty Tier, Vaccines												
H1170	002	0	1	01	01	H1170_002_0	12	Generic	4	010000	1	2	2	3	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 Brand, Specialty Tier, Vaccines										1		
H1170	002	0	1	01	01	H1170_002_0	12	Preferred Brand	4	000001	1	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	44.00		132.00																			44.00		88.00																44.00				44.00		1.46			1.46			1.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	002	0	1	01	01	H1170_002_0	12	Non-Preferred Brand	4	100000	1	2	4	1	110		01	110		1	30		90				2	2	30		90				30		31	85.00		255.00																			85.00		170.00																85.00				85.00		2.83			2.83			2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	002	0	1	01	01	H1170_002_0	12	Specialty Tier	4	010010	1	1	5	1	110		01	110		1	30		90				2	2	30		90				30		31				2246.00	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	12	Vaccines	4	000001	1	2	6	1	010		01			1	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	12	Vaccines	4	000001	1	2	6	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	11	Preferred Generic	3	001000	1	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	8.00		24.00																			8.00		0.00																8.00				8.00		0.26			0.26			0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	008	0	1	01	01	H1170_008_0	11	Generic	3	010000	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	20.00		60.00																			20.00		40.00																20.00				20.00		0.66			0.66			0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	008	0	1	01	01	H1170_008_0	11	Preferred Brand	3	000001	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 Brand, Specialty Tier, Vaccines												
H1170	008	0	1	01	01	H1170_008_0	11	Non-Preferred Brand	3	100000	1	2	4	1	110		01	110		1	30		90				2	2	30		90				30		31	100.00		300.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	008	0	1	01	01	H1170_008_0	11	Specialty Tier	3	010010	1	1	5	1	110		01	110		1	30		90				2	2	30		90				30		31				1472.00	33		33																		33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	008	0	1	01	01	H1170_008_0	11	Vaccines	3	000001	1	2	6	1	010		01			1	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	11	Preferred Generic	4	001000	1	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	7.00		21.00																			7.00		0.00																7.00				7.00		0.23			0.23			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	009	0	1	01	01	H1170_009_0	11	Preferred Generic	4	001000	1	2	1	3	110		01	110		1	30		90				2	2	30		90				30		31	7.00		21.00																			7.00		0.00																7.00				7.00		0.23			0.23			0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H1170	009	0	1	01	01	H1170_009_0	11	Generic	4	010000	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	20.00		60.00																			20.00		40.00																20.00				20.00		0.66			0.66			0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	009	0	1	01	01	H1170_009_0	11	Generic	4	010000	1	2	2	3	110		01	110		1	30		90				2	2	30		90				30		31	20.00		60.00																			20.00		40.00																20.00				20.00		0.66			0.66			0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H1170	009	0	1	01	01	H1170_009_0	11	Preferred Brand	4	000001	1	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	44.00		132.00																			44.00		88.00																44.00				44.00		1.46			1.46			1.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1170	009	0	1	01	01	H1170_009_0	11	Non-Preferred Brand	4	100000	1	2	4	1	110		01	110		1	30		90				2	2	30		90				30		31	95.00		285.00																			95.00		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	11	Specialty Tier	4	010010	1	1	5	1	110		01	110		1	30		90				2	2	30		90				30		31				1677.00	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	11	Vaccines	4	000001	1	2	6	1	010		01			1	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	11	Vaccines	4	000001	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H1189	001	0	1	01	01	H1189_001_0	13	Preferred Generic	3	001000	1	2	1	1	110		01	100		1	31		90				1	2			90				31		34	4.00		12.00																					8.00																4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1189	001	0	1	01	01	H1189_001_0	13	Generic	3	010000	1	2	2	1	110		01	100		1	31		90				1	2			90				31		34	10.00		30.00																					20.00																10.00				10.00		0.32						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1189	001	0	1	01	01	H1189_001_0	13	Preferred Brand	3	000001	1	2	3	1	110		01	100		1	31		90				1	2			90				31		34	35.00		105.00																					70.00																35.00				35.00		1.13						1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1189	001	0	1	01	01	H1189_001_0	13	Non-Preferred Drug	3	100000	1	2	4	1	110		01	100		1	31		90				1	2			90				31		34	90.00		270.00																					180.00																90.00				90.00		2.90						2.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1189	001	0	1	01	01	H1189_001_0	13	Specialty Tier	3	001101	1	1	5	1	110		01	100		1	31		90				1	2			90				31		34				1364.19	29		29																				29															29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1230	001	0	1	01	01	H1230_001_0	13	Preferred Generic	4	001000	1	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	3.00		9.00																			3.00		6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	001	0	1	01	01	H1230_001_0	13	Preferred Generic	4	001000	1	2	1	3	110		01	110		1	30		90				2	2	30		90				30		31	3.00		9.00																			3.00		6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H1230	001	0	1	01	01	H1230_001_0	13	Generic	4	010000	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 Brand, Specialty Tier, Vaccines												
H1230	001	0	1	01	01	H1230_001_0	13	Generic	4	010000	1	2	2	3	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 Brand, Specialty Tier, Vaccines										1		
H1230	001	0	1	01	01	H1230_001_0	13	Preferred Brand	4	000001	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 Brand, Specialty Tier, Vaccines												
H1230	001	0	1	01	01	H1230_001_0	13	Non-Preferred Brand	4	100000	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 Brand, Specialty Tier, Vaccines												
H1230	001	0	1	01	01	H1230_001_0	13	Specialty Tier	4	010010	1	1	5	1	110		01	110		1	30		90				2	2	30		90				30		31				1503.00	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	13	Vaccines	4	000001	1	2	6	1	010		01			1	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	13	Vaccines	4	000001	1	2	6	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	14	Preferred Generic	4	001000	1	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	3.00		9.00																			3.00		6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	003	0	1	01	01	H1230_003_0	14	Preferred Generic	4	001000	1	2	1	3	110		01	110		1	30		90				2	2	30		90				30		31	3.00		9.00																			3.00		6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H1230	003	0	1	01	01	H1230_003_0	14	Generic	4	010000	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 Brand, Specialty Tier, Vaccines												
H1230	003	0	1	01	01	H1230_003_0	14	Generic	4	010000	1	2	2	3	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 Brand, Specialty Tier, Vaccines										1		
H1230	003	0	1	01	01	H1230_003_0	14	Preferred Brand	4	000001	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 Brand, Specialty Tier, Vaccines												
H1230	003	0	1	01	01	H1230_003_0	14	Non-Preferred Brand	4	100000	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 Brand, Specialty Tier, Vaccines												
H1230	003	0	1	01	01	H1230_003_0	14	Specialty Tier	4	010010	1	1	5	1	110		01	110		1	30		90				2	2	30		90				30		31				1769.00	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	14	Vaccines	4	000001	1	2	6	1	010		01			1	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	14	Vaccines	4	000001	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H1230	013	0	1	01	01	H1230_013_0	14	Preferred Generic	3	001000	1	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	4.00		12.00																			4.00		8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	013	0	1	01	01	H1230_013_0	14	Generic	3	010000	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	11.00		33.00																			11.00		22.00																11.00				11.00		0.37			0.37			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	013	0	1	01	01	H1230_013_0	14	Preferred Brand	3	000001	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 Brand, Specialty Tier, Vaccines												
H1230	013	0	1	01	01	H1230_013_0	14	Non-Preferred Brand	3	100000	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 Brand, Specialty Tier, Vaccines												
H1230	013	0	1	01	01	H1230_013_0	14	Specialty Tier	3	010010	1	1	5	1	110		01	110		1	30		90				2	2	30		90				30		31				1487.00	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	013	0	1	01	01	H1230_013_0	14	Vaccines	3	000001	1	2	6	1	010		01			1	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	15	Preferred Generic	3	001000	1	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	4.00		12.00																			4.00		8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	014	0	1	01	01	H1230_014_0	15	Generic	3	010000	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	13.00		39.00																			13.00		26.00																13.00				13.00		0.43			0.43			0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	014	0	1	01	01	H1230_014_0	15	Preferred Brand	3	000001	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 Brand, Specialty Tier, Vaccines												
H1230	014	0	1	01	01	H1230_014_0	15	Non-Preferred Brand	3	100000	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 Brand, Specialty Tier, Vaccines												
H1230	014	0	1	01	01	H1230_014_0	15	Specialty Tier	3	010010	1	1	5	1	110		01	110		1	30		90				2	2	30		90				30		31				1123.00	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1230	014	0	1	01	01	H1230_014_0	15	Vaccines	3	000001	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H1264	004	0	1	02	01	H1264_004_0	5	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	4.00		12.00																									4.00		12.00				4.00		0.00				4.00				4.00		0.13				0.13	0.13	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1264	004	0	1	02	01	H1264_004_0	5	Generic	4	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		50.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1264	004	0	1	02	01	H1264_004_0	5	Preferred Brand	4	000101	1	2	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												
H1264	004	0	1	02	01	H1264_004_0	5	Non-Preferred Drug	4	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				84.13	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1264	004	0	1	02	01	H1264_004_0	5	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				2569.31	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1264	007	0	1	01	01	H1264_007_0	5	Preferred Generic	2	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	2.00		6.00																									2.00		6.00				2.00		0.00				2.00				2.00		0.07				0.07	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1264	007	0	1	01	01	H1264_007_0	5	Generic	2	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		12.50				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1264	007	0	1	01	01	H1264_007_0	5	Preferred Brand	2	000101	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	32.00		96.00																									32.00		96.00				32.00		80.00				32.00				32.00		1.07				1.07	1.07	1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1264	007	0	1	01	01	H1264_007_0	5	Non-Preferred Drug	2	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				94.19	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1264	007	0	1	01	01	H1264_007_0	5	Specialty Tier	2	010010	1	1	5	1	010		01		010	1	30											30			30		31				2240.08	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1264	008	0	1	01	01	H1264_008_0	5	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1264	008	0	1	01	01	H1264_008_0	5	Generic	4	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		50.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1264	008	0	1	01	01	H1264_008_0	5	Preferred Brand	4	000101	1	2	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												
H1264	008	0	1	01	01	H1264_008_0	5	Non-Preferred Drug	4	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				77.40	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1264	008	0	1	01	01	H1264_008_0	5	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				2561.58	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1264	018	0	1	01	01	H1264_018_0	6	Preferred Generic	2	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	2.00		6.00																									2.00		6.00				2.00		0.00				2.00				2.00		0.07				0.07	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1264	018	0	1	01	01	H1264_018_0	6	Generic	2	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	8.00		24.00																									8.00		24.00				8.00		20.00				8.00				8.00		0.27				0.27	0.27	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1264	018	0	1	01	01	H1264_018_0	6	Preferred Brand	2	000101	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	33.00		99.00																									33.00		99.00				33.00		82.50				33.00				33.00		1.10				1.10	1.10	1.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1264	018	0	1	01	01	H1264_018_0	6	Non-Preferred Drug	2	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				85.71	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1264	018	0	1	01	01	H1264_018_0	6	Specialty Tier	2	010010	1	1	5	1	010		01		010	1	30											30			30		31				2567.04	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1264	019	0	1	02	01	H1264_019_0	6	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1264	019	0	1	02	01	H1264_019_0	6	Generic	4	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		17.50				7.00				7.00		0.23				0.23	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1264	019	0	1	02	01	H1264_019_0	6	Preferred Brand	4	000101	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	30.00		90.00																									30.00		90.00				30.00		75.00				30.00				30.00		1.00				1.00	1.00	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1264	019	0	1	02	01	H1264_019_0	6	Non-Preferred Drug	4	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				81.96	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1264	019	0	1	02	01	H1264_019_0	6	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				2552.08	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1264	020	0	1	01	01	H1264_020_0	5	Preferred Generic	2	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	2.00		6.00																									2.00		6.00				2.00		0.00				2.00				2.00		0.07				0.07	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1264	020	0	1	01	01	H1264_020_0	5	Generic	2	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		12.50				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1264	020	0	1	01	01	H1264_020_0	5	Preferred Brand	2	000101	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	32.00		96.00																									32.00		96.00				32.00		80.00				32.00				32.00		1.07				1.07	1.07	1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1264	020	0	1	01	01	H1264_020_0	5	Non-Preferred Drug	2	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				94.05	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1264	020	0	1	01	01	H1264_020_0	5	Specialty Tier	2	010010	1	1	5	1	010		01		010	1	30											30			30		31				2247.81	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1264	021	0	1	01	01	H1264_021_0	5	Preferred Generic	2	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	2.00		6.00																									2.00		6.00				2.00		0.00				2.00				2.00		0.07				0.07	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1264	021	0	1	01	01	H1264_021_0	5	Generic	2	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		12.50				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1264	021	0	1	01	01	H1264_021_0	5	Preferred Brand	2	000101	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	32.00		96.00																									32.00		96.00				32.00		80.00				32.00				32.00		1.07				1.07	1.07	1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1264	021	0	1	01	01	H1264_021_0	5	Non-Preferred Drug	2	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				94.05	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1264	021	0	1	01	01	H1264_021_0	5	Specialty Tier	2	010010	1	1	5	1	010		01		010	1	30											30			30		31				2247.81	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1264	022	0	1	01	01	H1264_022_0	5	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1264	022	0	1	01	01	H1264_022_0	5	Generic	4	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		50.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1264	022	0	1	01	01	H1264_022_0	5	Preferred Brand	4	000101	1	2	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												
H1264	022	0	1	01	01	H1264_022_0	5	Non-Preferred Drug	4	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				78.12	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1264	022	0	1	01	01	H1264_022_0	5	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				2574.37	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1286	002	0	1	01	01	H1286_002_0	5	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1286	002	0	1	01	01	H1286_002_0	5	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1286	002	0	1	01	01	H1286_002_0	5	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1286	002	0	1	01	01	H1286_002_0	5	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1286	002	0	1	01	01	H1286_002_0	5	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				618.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1286	009	0	1	01	01	H1286_009_0	5	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1286	009	0	1	01	01	H1286_009_0	5	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1286	009	0	1	01	01	H1286_009_0	5	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1286	009	0	1	01	01	H1286_009_0	5	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1286	009	0	1	01	01	H1286_009_0	5	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				678.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1304	002	0	1	04	01	H1304_002_0	6	Preferred Generic	3	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	10.00																			5.00	10.00	10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1304	002	0	1	04	01	H1304_002_0	6	Generic	3	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	30.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1304	002	0	1	04	01	H1304_002_0	6	Preferred Brand	3	000001	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, Select Care Drugs												
H1304	002	0	1	04	01	H1304_002_0	6	Non-Preferred Drug	3	100100	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				85.50	45	45	45																		45	45	45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1304	002	0	1	04	01	H1304_002_0	6	Specialty Tier	3	010010	1	1	5	1	010		01	010		1	30								30						30		31				1044.40	28																				28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1304	002	0	1	04	01	H1304_002_0	6	Select Care Drugs	3	010000	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1304	004	0	1	04	01	H1304_004_0	6	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	6.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1304	004	0	1	04	01	H1304_004_0	6	Generic	4	010000	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, Select Care Drugs												
H1304	004	0	1	04	01	H1304_004_0	6	Preferred Brand	4	000001	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, Select Care Drugs												
H1304	004	0	1	04	01	H1304_004_0	6	Non-Preferred Drug	4	100100	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				76.00	40	40	40																		40	40	40															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1304	004	0	1	04	01	H1304_004_0	6	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31				1230.90	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1304	004	0	1	04	01	H1304_004_0	6	Select Care Drugs	4	010000	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1304	009	0	1	04	01	H1304_009_0	6	Preferred Generic	3	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	10.00																			5.00	10.00	10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1304	009	0	1	04	01	H1304_009_0	6	Generic	3	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	40.00																			20.00	40.00	40.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1304	009	0	1	04	01	H1304_009_0	6	Preferred Brand	3	000001	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, Select Care Drugs												
H1304	009	0	1	04	01	H1304_009_0	6	Non-Preferred Drug	3	100100	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				85.50	45	45	45																		45	45	45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1304	009	0	1	04	01	H1304_009_0	6	Specialty Tier	3	010010	1	1	5	1	010		01	010		1	30								30						30		31				1044.40	28																				28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1304	009	0	1	04	01	H1304_009_0	6	Select Care Drugs	3	010000	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1304	010	0	1	04	01	H1304_010_0	6	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	6.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1304	010	0	1	04	01	H1304_010_0	6	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	9.00	18.00	18.00																			9.00	18.00	18.00																9.00				9.00		0.30			0.30			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1304	010	0	1	04	01	H1304_010_0	6	Preferred Brand	4	000001	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, Select Care Drugs												
H1304	010	0	1	04	01	H1304_010_0	6	Non-Preferred Drug	4	100100	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				76.00	40	40	40																		40	40	40															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1304	010	0	1	04	01	H1304_010_0	6	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31				1230.90	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1304	010	0	1	04	01	H1304_010_0	6	Select Care Drugs	4	010000	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1343	001	0	1	01	01	H1343_001_0	7	Preferred Generic	4	001000	1	2	1	1	110		10	100		1	31		90				1	2			90					10	31	0.00		0.00																					0.00																	0.00			0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1343	001	0	1	01	01	H1343_001_0	7	Generic	4	010000	1	1	2	1	110		10	100		1	31		90				1	2			90					10	31				14.90	25		25																				25																25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1343	001	0	1	01	01	H1343_001_0	7	Preferred Brand	4	000001	1	1	3	1	110		10	100		1	31		90				1	2			90					10	31				67.40	25		25																				25																25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1343	001	0	1	01	01	H1343_001_0	7	Non-Preferred Brand	4	100000	1	1	4	1	110		10	100		1	31		90				1	2			90					10	31				188.71	25		25																				25																25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1343	001	0	1	01	01	H1343_001_0	7	Specialty Tier	4	010010	1	1	5	1	010		10	010		1	31								30							10	31				600.00	25																				25																		25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1350	015	1	1	01	01	H1350_015_1	6	Preferred Generic	4	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				0.00			0.17	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1350	015	1	1	01	01	H1350_015_1	6	Generic	4	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								12.00		36.00					6.00		18.00													36.00						18.00				12.00				6.00			0.40	0.20				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1350	015	1	1	01	01	H1350_015_1	6	Preferred Brand	4	000001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								45.00		135.00					35.00		105.00													135.00						105.00				45.00				35.00			1.50	1.17				1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1350	015	1	1	01	01	H1350_015_1	6	Non-Preferred Drug	4	100000	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								95.00		285.00					85.00		255.00													285.00						255.00				95.00				85.00			3.17	2.83				2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1350	015	1	1	01	01	H1350_015_1	6	Specialty Tier	4	110001	1	1	5	1		110	01		010	1				30		90	1	2				30			30		31											990.00	33		33				990.00	33		33										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1350	015	2	1	01	01	H1350_015_2	6	Preferred Generic	4	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					0.00		0.00													15.00						0.00				5.00				0.00			0.17	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1350	015	2	1	01	01	H1350_015_2	6	Generic	4	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								12.00		36.00					6.00		18.00													36.00						18.00				12.00				6.00			0.40	0.20				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1350	015	2	1	01	01	H1350_015_2	6	Preferred Brand	4	000001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								45.00		135.00					35.00		105.00													135.00						105.00				45.00				35.00			1.50	1.17				1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1350	015	2	1	01	01	H1350_015_2	6	Non-Preferred Drug	4	100000	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								95.00		285.00					85.00		255.00													285.00						255.00				95.00				85.00			3.17	2.83				2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1350	015	2	1	01	01	H1350_015_2	6	Specialty Tier	4	110001	1	1	5	1		110	01		010	1				30		90	1	2				30			30		31											990.00	33		33				990.00	33		33										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1350	016	1	1	01	01	H1350_016_1	6	Preferred Generic	4	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				0.00			0.33	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1350	016	1	1	01	01	H1350_016_1	6	Generic	4	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					12.00		36.00													60.00						36.00				20.00				12.00			0.67	0.40				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1350	016	1	1	01	01	H1350_016_1	6	Preferred Brand	4	000001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					37.00		111.00													141.00						111.00				47.00				37.00			1.57	1.23				1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1350	016	1	1	01	01	H1350_016_1	6	Non-Preferred Drug	4	100000	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		300.00					90.00		270.00													300.00						270.00				100.00				90.00			3.33	3.00				2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1350	016	1	1	01	01	H1350_016_1	6	Specialty Tier	4	110001	1	1	5	1		110	01		010	1				30		90	1	2				30			30		31											990.00	29		29				990.00	29		29										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1350	016	2	1	01	01	H1350_016_2	6	Preferred Generic	4	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					0.00		0.00													30.00						0.00				10.00				0.00			0.33	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1350	016	2	1	01	01	H1350_016_2	6	Generic	4	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					12.00		36.00													60.00						36.00				20.00				12.00			0.67	0.40				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1350	016	2	1	01	01	H1350_016_2	6	Preferred Brand	4	000001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					37.00		111.00													141.00						111.00				47.00				37.00			1.57	1.23				1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1350	016	2	1	01	01	H1350_016_2	6	Non-Preferred Drug	4	100000	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		300.00					90.00		270.00													300.00						270.00				100.00				90.00			3.33	3.00				2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1350	016	2	1	01	01	H1350_016_2	6	Specialty Tier	4	110001	1	1	5	1		110	01		010	1				30		90	1	2				30			30		31											990.00	29		29				990.00	29		29										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1350	019	1	1	01	01	H1350_019_1	6	Preferred Generic	3	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				0.00			0.50	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1350	019	1	1	01	01	H1350_019_1	6	Generic	3	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				6.00			0.67	0.20				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1350	019	1	1	01	01	H1350_019_1	6	Preferred Brand	3	000001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					36.00		108.00													141.00						108.00				47.00				36.00			1.57	1.20				1.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1350	019	1	1	01	01	H1350_019_1	6	Non-Preferred Drug	3	100000	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		300.00					85.00		255.00													300.00						255.00				100.00				85.00			3.33	2.83				2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1350	019	1	1	01	01	H1350_019_1	6	Specialty Tier	3	110001	1	1	5	1		110	01		010	1				30		90	1	2				30			30		31											990.00	33		33				990.00	33		33										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1350	019	2	1	01	01	H1350_019_2	6	Preferred Generic	3	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				0.00			0.50	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1350	019	2	1	01	01	H1350_019_2	6	Generic	3	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					6.00		18.00													60.00						18.00				20.00				6.00			0.67	0.20				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1350	019	2	1	01	01	H1350_019_2	6	Preferred Brand	3	000001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					36.00		108.00													141.00						108.00				47.00				36.00			1.57	1.20				1.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1350	019	2	1	01	01	H1350_019_2	6	Non-Preferred Drug	3	100000	1	2	4	1		110	01		100	1				30		90	1	2						90	30		31								100.00		300.00					85.00		255.00													300.00						255.00				100.00				85.00			3.33	2.83				2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1350	019	2	1	01	01	H1350_019_2	6	Specialty Tier	3	110001	1	1	5	1		110	01		010	1				30		90	1	2				30			30		31											990.00	33		33				990.00	33		33										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1352	001	0	1	01	01	H1352_001_0	8	Preferred Generic	4	001000	1	2	1	1		111	01	100		1				30	60	90	1	2			90				30		31								15.00	30.00	45.00					3.00	6.00	9.00							0.00																15.00				15.00			0.50	0.10				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1352	001	0	1	01	01	H1352_001_0	8	Generic	4	010000	1	2	2	1		111	01	100		1				30	60	90	1	2			90				30		31								20.00	40.00	60.00					15.00	30.00	45.00							0.00																20.00				20.00			0.67	0.50				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1352	001	0	1	01	01	H1352_001_0	8	Preferred Brand	4	000001	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												
H1352	001	0	1	01	01	H1352_001_0	8	Non-Preferred Brand	4	100000	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												
H1352	001	0	1	01	01	H1352_001_0	8	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		31											1.00	33						1.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1352	002	0	1	01	01	H1352_002_0	7	Preferred Generic	4	001000	1	2	1	1		111	01	100		1				30	60	90	1	2			90				30		31								8.00	16.00	24.00					3.00	6.00	9.00							0.00																8.00				8.00			0.27	0.10				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1352	002	0	1	01	01	H1352_002_0	7	Generic	4	010000	1	2	2	1		111	01	100		1				30	60	90	1	2			90				30		31								13.00	26.00	39.00					8.00	16.00	24.00							0.00																13.00				13.00			0.43	0.27				0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1352	002	0	1	01	01	H1352_002_0	7	Preferred Brand	4	000001	1	2	3	1		111	01	100		1				30	60	90	1	2			90				30		31								47.00	94.00	141.00					35.00	70.00	105.00							87.50																47.00				47.00			1.57	1.17				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1352	002	0	1	01	01	H1352_002_0	7	Non-Preferred Brand	4	100000	1	2	4	1		111	01	100		1				30	60	90	1	2			90				30		31								100.00	200.00	300.00					90.00	180.00	270.00							225.00																100.00				100.00			3.33	3.00				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1352	002	0	1	01	01	H1352_002_0	7	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		31											1.00	33						1.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1365	001	0	1	04	01	H1365_001_0	10	Preferred Generic	4	001001	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	10	Generic	4	010001	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	10	Preferred Brand	4	000101	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	10	Non-Preferred Drug	4	100100	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	10	Specialty Tier	4	000010	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											600.00	33	33	33				600.00	33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1365	002	0	1	04	01	H1365_002_0	11	Preferred Generic	4	001001	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								4.00	8.00	12.00					0.00	0.00	0.00					4.00	8.00	10.00																4.00				4.00			0.13	0.00	0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1365	002	0	1	04	01	H1365_002_0	11	Generic	4	010001	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					10.00	20.00	30.00					18.00	36.00	45.00																18.00				18.00			0.60	0.33	0.60			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1365	002	0	1	04	01	H1365_002_0	11	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					47.00	94.00	117.50																47.00				47.00			1.57	1.33	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1365	002	0	1	04	01	H1365_002_0	11	Non-Preferred Drug	4	100100	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00	200.00	250.00																100.00				100.00			3.33	3.17	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1365	002	0	1	04	01	H1365_002_0	11	Specialty Tier	4	000010	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	003	0	1	04	01	H1365_003_0	11	Preferred Generic	4	001001	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	003	0	1	04	01	H1365_003_0	11	Generic	4	010001	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	003	0	1	04	01	H1365_003_0	11	Preferred Brand	4	000101	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	003	0	1	04	01	H1365_003_0	11	Non-Preferred Drug	4	100100	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	003	0	1	04	01	H1365_003_0	11	Specialty Tier	4	000010	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												
H1394	003	0	1	01	01	H1394_003_0	7	Preferred Generic	4	001000	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												
H1394	003	0	1	01	01	H1394_003_0	7	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								13.00	26.00	39.00					8.00	16.00	24.00					8.00	24.00	24.00																13.00				13.00			0.43	0.27	0.27			0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1394	003	0	1	01	01	H1394_003_0	7	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	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												
H1394	003	0	1	01	01	H1394_003_0	7	Non-Preferred Drug	4	100100	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												
H1394	003	0	1	01	01	H1394_003_0	7	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1394	003	0	1	01	01	H1394_003_0	7	Select Care Drugs	4	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1394	003	0	1	01	01	H1394_003_0	7	Select Care Drugs	4	001000	1	2	6	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		
H1394	006	0	1	01	01	H1394_006_0	6	Preferred Generic	4	001000	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												
H1394	006	0	1	01	01	H1394_006_0	6	Generic	4	010000	1	2	2	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												
H1394	006	0	1	01	01	H1394_006_0	6	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								45.00	90.00	135.00					45.00	90.00	135.00					45.00	135.00	135.00																45.00				45.00			1.50	1.50	1.50			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1394	006	0	1	01	01	H1394_006_0	6	Non-Preferred Drug	4	100100	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												
H1394	006	0	1	01	01	H1394_006_0	6	Specialty Tier	4	010010	1	1	5	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												
H1394	006	0	1	01	01	H1394_006_0	6	Select Care Drugs	4	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1394	006	0	1	01	01	H1394_006_0	6	Select Care Drugs	4	001000	1	2	6	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		
H1394	009	0	1	01	01	H1394_009_0	8	Preferred Generic	4	001000	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												
H1394	009	0	1	01	01	H1394_009_0	8	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								13.00	26.00	39.00					8.00	16.00	24.00					8.00	24.00	24.00																13.00				13.00			0.43	0.27	0.27			0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1394	009	0	1	01	01	H1394_009_0	8	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	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												
H1394	009	0	1	01	01	H1394_009_0	8	Non-Preferred Drug	4	100100	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												
H1394	009	0	1	01	01	H1394_009_0	8	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1394	009	0	1	01	01	H1394_009_0	8	Select Care Drugs	4	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1394	009	0	1	01	01	H1394_009_0	8	Select Care Drugs	4	001000	1	2	6	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		
H1406	013	0	1	01	01	H1406_013_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1406	013	0	1	01	01	H1406_013_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1406	013	0	1	01	01	H1406_013_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1406	013	0	1	01	01	H1406_013_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1406	013	0	1	01	01	H1406_013_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1406	013	0	1	01	01	H1406_013_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1406	013	0	1	01	01	H1406_013_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1406	013	0	1	01	01	H1406_013_0	4	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1406	013	0	1	01	01	H1406_013_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1406	013	0	1	01	01	H1406_013_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1406	022	0	1	01	01	H1406_022_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1406	022	0	1	01	01	H1406_022_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1406	022	0	1	01	01	H1406_022_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1406	022	0	1	01	01	H1406_022_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1406	022	0	1	01	01	H1406_022_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1406	022	0	1	01	01	H1406_022_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1406	022	0	1	01	01	H1406_022_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1406	022	0	1	01	01	H1406_022_0	4	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1406	022	0	1	01	01	H1406_022_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1406	022	0	1	01	01	H1406_022_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1406	026	0	1	01	01	H1406_026_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1406	026	0	1	01	01	H1406_026_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1406	026	0	1	01	01	H1406_026_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1406	026	0	1	01	01	H1406_026_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1406	026	0	1	01	01	H1406_026_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1406	026	0	1	01	01	H1406_026_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1406	026	0	1	01	01	H1406_026_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1406	026	0	1	01	01	H1406_026_0	4	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1406	026	0	1	01	01	H1406_026_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1406	026	0	1	01	01	H1406_026_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1406	028	0	1	01	01	H1406_028_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1406	028	0	1	01	01	H1406_028_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1406	028	0	1	01	01	H1406_028_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1406	028	0	1	01	01	H1406_028_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1406	028	0	1	01	01	H1406_028_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1406	028	0	1	01	01	H1406_028_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1406	028	0	1	01	01	H1406_028_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1406	028	0	1	01	01	H1406_028_0	4	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1406	028	0	1	01	01	H1406_028_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1406	028	0	1	01	01	H1406_028_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1406	029	0	1	01	01	H1406_029_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1406	029	0	1	01	01	H1406_029_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H1406	029	0	1	01	01	H1406_029_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1406	029	0	1	01	01	H1406_029_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H1406	029	0	1	01	01	H1406_029_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				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												
H1406	029	0	1	01	01	H1406_029_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H1406	029	0	1	01	01	H1406_029_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1406	029	0	1	01	01	H1406_029_0	4	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H1406	029	0	1	01	01	H1406_029_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1406	029	0	1	01	01	H1406_029_0	4	Specialty Tier	4	010010	1	1	5	3		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										2	3	
H1406	029	0	1	01	01	H1406_029_0	4	Select Care Drugs	4	010010	1	2	6	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1406	032	0	1	01	01	H1406_032_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1406	032	0	1	01	01	H1406_032_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H1406	032	0	1	01	01	H1406_032_0	3	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1406	032	0	1	01	01	H1406_032_0	3	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H1406	032	0	1	01	01	H1406_032_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				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												
H1406	032	0	1	01	01	H1406_032_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H1406	032	0	1	01	01	H1406_032_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1406	032	0	1	01	01	H1406_032_0	3	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H1406	032	0	1	01	01	H1406_032_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1406	032	0	1	01	01	H1406_032_0	3	Specialty Tier	4	010010	1	1	5	3		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										2	3	
H1406	032	0	1	01	01	H1406_032_0	3	Select Care Drugs	4	010010	1	2	6	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1415	021	0	1	02	01	H1415_021_0	4	Preferred Generic	4	001000	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		31								10.00	20.00	30.00					5.00	10.00	12.50					10.00		30.00																10.00				10.00			0.33	0.17	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1415	021	0	1	02	01	H1415_021_0	4	Generic	4	010000	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		31								15.00	30.00	45.00					10.00	20.00	25.00					15.00		45.00																15.00				15.00			0.50	0.33	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1415	021	0	1	02	01	H1415_021_0	4	Preferred Brand	4	000101	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		31								47.00	94.00	141.00					42.00	84.00	105.00					47.00		141.00																47.00				47.00			1.57	1.40	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1415	021	0	1	02	01	H1415_021_0	4	Non-Preferred Drug	4	100100	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		31								100.00	200.00	300.00					95.00	190.00	237.50					100.00		300.00																100.00				100.00			3.33	3.17	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1415	021	0	1	02	01	H1415_021_0	4	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		31											632.63	33						512.71	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	007	0	1	01	01	H1416_007_0	5	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	007	0	1	01	01	H1416_007_0	5	Generic	4	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		50.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	007	0	1	01	01	H1416_007_0	5	Preferred Brand	4	000101	1	2	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												
H1416	007	0	1	01	01	H1416_007_0	5	Non-Preferred Drug	4	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				91.60	47		47																								47		47				47		47			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	007	0	1	01	01	H1416_007_0	5	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				2237.65	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	009	0	1	02	01	H1416_009_0	5	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	4.00		12.00																									4.00		12.00				4.00		0.00				4.00				4.00		0.13				0.13	0.13	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	009	0	1	02	01	H1416_009_0	5	Generic	4	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		37.50				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	009	0	1	02	01	H1416_009_0	5	Preferred Brand	4	000101	1	2	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												
H1416	009	0	1	02	01	H1416_009_0	5	Non-Preferred Drug	4	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				82.32	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	009	0	1	02	01	H1416_009_0	5	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				2827.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	023	0	1	01	01	H1416_023_0	5	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	023	0	1	01	01	H1416_023_0	5	Generic	4	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		50.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	023	0	1	01	01	H1416_023_0	5	Preferred Brand	4	000101	1	2	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												
H1416	023	0	1	01	01	H1416_023_0	5	Non-Preferred Drug	4	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				90.20	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	023	0	1	01	01	H1416_023_0	5	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				2488.32	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	024	0	1	02	01	H1416_024_0	5	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	024	0	1	02	01	H1416_024_0	5	Generic	4	010001	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		25.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	024	0	1	02	01	H1416_024_0	5	Preferred Brand	4	000101	1	2	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												
H1416	024	0	1	02	01	H1416_024_0	5	Non-Preferred Drug	4	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				89.84	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	024	0	1	02	01	H1416_024_0	5	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				2866.85	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	026	0	1	02	01	H1416_026_0	5	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	026	0	1	02	01	H1416_026_0	5	Generic	4	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		37.50				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	026	0	1	02	01	H1416_026_0	5	Preferred Brand	4	000101	1	2	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												
H1416	026	0	1	02	01	H1416_026_0	5	Non-Preferred Drug	4	100100	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		247.50				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	026	0	1	02	01	H1416_026_0	5	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				2799.05	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	031	0	1	01	01	H1416_031_0	6	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	031	0	1	01	01	H1416_031_0	6	Generic	4	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		50.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	031	0	1	01	01	H1416_031_0	6	Preferred Brand	4	000101	1	2	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												
H1416	031	0	1	01	01	H1416_031_0	6	Non-Preferred Drug	4	100100	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		247.50				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	031	0	1	01	01	H1416_031_0	6	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				2284.16	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	032	0	1	02	01	H1416_032_0	5	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	032	0	1	02	01	H1416_032_0	5	Generic	4	010001	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		30.00				12.00				12.00		0.40				0.40	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	032	0	1	02	01	H1416_032_0	5	Preferred Brand	4	000101	1	2	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												
H1416	032	0	1	02	01	H1416_032_0	5	Non-Preferred Drug	4	100100	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		247.50				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	032	0	1	02	01	H1416_032_0	5	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				2908.28	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	033	0	1	01	01	H1416_033_0	5	Preferred Generic	3	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	033	0	1	01	01	H1416_033_0	5	Generic	3	010001	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		25.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	033	0	1	01	01	H1416_033_0	5	Preferred Brand	3	000101	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	44.00		132.00																									44.00		132.00				44.00		110.00				44.00				44.00		1.47				1.47	1.47	1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	033	0	1	01	01	H1416_033_0	5	Non-Preferred Drug	3	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				87.41	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	033	0	1	01	01	H1416_033_0	5	Specialty Tier	3	010010	1	1	5	1	010		01		010	1	30											30			30		31				2392.09	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	034	0	1	01	01	H1416_034_0	5	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	034	0	1	01	01	H1416_034_0	5	Generic	4	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		50.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	034	0	1	01	01	H1416_034_0	5	Preferred Brand	4	000101	1	2	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												
H1416	034	0	1	01	01	H1416_034_0	5	Non-Preferred Drug	4	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				87.21	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	034	0	1	01	01	H1416_034_0	5	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				2326.01	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	035	0	1	01	01	H1416_035_0	5	Preferred Generic	3	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	035	0	1	01	01	H1416_035_0	5	Generic	3	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		37.50				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	035	0	1	01	01	H1416_035_0	5	Preferred Brand	3	000101	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	36.00		108.00																									36.00		108.00				36.00		90.00				36.00				36.00		1.20				1.20	1.20	1.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	035	0	1	01	01	H1416_035_0	5	Non-Preferred Drug	3	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				98.24	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	035	0	1	01	01	H1416_035_0	5	Specialty Tier	3	010010	1	1	5	1	010		01		010	1	30											30			30		31				2203.82	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	036	0	1	01	01	H1416_036_0	5	Preferred Generic	3	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	036	0	1	01	01	H1416_036_0	5	Generic	3	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	13.00		39.00																									13.00		39.00				13.00		32.50				13.00				13.00		0.43				0.43	0.43	0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	036	0	1	01	01	H1416_036_0	5	Preferred Brand	3	000101	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	41.00		123.00																									41.00		123.00				41.00		102.50				41.00				41.00		1.37				1.37	1.37	1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	036	0	1	01	01	H1416_036_0	5	Non-Preferred Drug	3	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				92.02	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	036	0	1	01	01	H1416_036_0	5	Specialty Tier	3	010010	1	1	5	1	010		01		010	1	30											30			30		31				2066.69	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	037	0	1	01	01	H1416_037_0	5	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	037	0	1	01	01	H1416_037_0	5	Generic	4	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		50.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	037	0	1	01	01	H1416_037_0	5	Preferred Brand	4	000101	1	2	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												
H1416	037	0	1	01	01	H1416_037_0	5	Non-Preferred Drug	4	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				86.47	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	037	0	1	01	01	H1416_037_0	5	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				2551.22	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	038	0	1	01	01	H1416_038_0	5	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	038	0	1	01	01	H1416_038_0	5	Generic	4	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		50.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	038	0	1	01	01	H1416_038_0	5	Preferred Brand	4	000101	1	2	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												
H1416	038	0	1	01	01	H1416_038_0	5	Non-Preferred Drug	4	100100	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		247.50				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	038	0	1	01	01	H1416_038_0	5	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				2431.25	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	039	0	1	02	01	H1416_039_0	5	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	039	0	1	02	01	H1416_039_0	5	Generic	4	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		50.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	039	0	1	02	01	H1416_039_0	5	Preferred Brand	4	000101	1	2	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												
H1416	039	0	1	02	01	H1416_039_0	5	Non-Preferred Drug	4	100100	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		247.50				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	039	0	1	02	01	H1416_039_0	5	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				2489.71	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	040	0	1	01	01	H1416_040_0	5	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	040	0	1	01	01	H1416_040_0	5	Generic	4	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		50.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	040	0	1	01	01	H1416_040_0	5	Preferred Brand	4	000101	1	2	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												
H1416	040	0	1	01	01	H1416_040_0	5	Non-Preferred Drug	4	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				78.42	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	040	0	1	01	01	H1416_040_0	5	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				2027.22	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	041	0	1	01	01	H1416_041_0	5	Preferred Generic	2	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	2.00		6.00																									2.00		6.00				2.00		0.00				2.00				2.00		0.07				0.07	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	041	0	1	01	01	H1416_041_0	5	Generic	2	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		12.50				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	041	0	1	01	01	H1416_041_0	5	Preferred Brand	2	000101	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	37.00		111.00																									37.00		111.00				37.00		92.50				37.00				37.00		1.23				1.23	1.23	1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	041	0	1	01	01	H1416_041_0	5	Non-Preferred Drug	2	100100	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		247.50				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	041	0	1	01	01	H1416_041_0	5	Specialty Tier	2	010010	1	1	5	1	010		01		010	1	30											30			30		31				2388.73	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	042	0	1	01	01	H1416_042_0	5	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	2.00		6.00																									2.00		6.00				2.00		0.00				2.00				2.00		0.07				0.07	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	042	0	1	01	01	H1416_042_0	5	Generic	4	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	3.00		9.00																									3.00		9.00				3.00		7.50				3.00				3.00		0.10				0.10	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	042	0	1	01	01	H1416_042_0	5	Preferred Brand	4	000101	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	40.00		120.00																									40.00		120.00				40.00		100.00				40.00				40.00		1.33				1.33	1.33	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	042	0	1	01	01	H1416_042_0	5	Non-Preferred Drug	4	100100	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		247.50				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	042	0	1	01	01	H1416_042_0	5	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				2191.51	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	043	0	1	01	01	H1416_043_0	5	Preferred Generic	3	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	043	0	1	01	01	H1416_043_0	5	Generic	3	010001	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		22.50				9.00				9.00		0.30				0.30	0.30	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	043	0	1	01	01	H1416_043_0	5	Preferred Brand	3	000101	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	44.00		132.00																									44.00		132.00				44.00		110.00				44.00				44.00		1.47				1.47	1.47	1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	043	0	1	01	01	H1416_043_0	5	Non-Preferred Drug	3	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				79.50	47		47																								47		47				47		47			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	043	0	1	01	01	H1416_043_0	5	Specialty Tier	3	010010	1	1	5	1	010		01		010	1	30											30			30		31				2388.82	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	044	0	1	01	01	H1416_044_0	5	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	044	0	1	01	01	H1416_044_0	5	Generic	4	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		50.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	044	0	1	01	01	H1416_044_0	5	Preferred Brand	4	000101	1	2	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												
H1416	044	0	1	01	01	H1416_044_0	5	Non-Preferred Drug	4	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				85.75	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	044	0	1	01	01	H1416_044_0	5	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				2360.21	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	048	0	1	01	01	H1416_048_0	5	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	048	0	1	01	01	H1416_048_0	5	Generic	4	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		50.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	048	0	1	01	01	H1416_048_0	5	Preferred Brand	4	000101	1	2	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												
H1416	048	0	1	01	01	H1416_048_0	5	Non-Preferred Drug	4	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				99.26	47		47																								47		47				47		47			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	048	0	1	01	01	H1416_048_0	5	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				2235.38	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	049	0	1	01	01	H1416_049_0	5	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	049	0	1	01	01	H1416_049_0	5	Generic	4	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		50.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	049	0	1	01	01	H1416_049_0	5	Preferred Brand	4	000101	1	2	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												
H1416	049	0	1	01	01	H1416_049_0	5	Non-Preferred Drug	4	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				99.26	47		47																								47		47				47		47			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1416	049	0	1	01	01	H1416_049_0	5	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				2235.38	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	003	0	1	01	01	H1463_003_0	5	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	22.50					0.00	0.00	0.00					9.00	18.00	22.50																9.00				9.00			0.30	0.00	0.30			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	003	0	1	01	01	H1463_003_0	5	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	50.00					20.00	40.00	40.00					20.00	40.00	50.00																20.00				20.00			0.67	0.67	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	003	0	1	01	01	H1463_003_0	5	Preferred Brand	4	000001	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	117.50					47.00	94.00	94.00					47.00	94.00	117.50																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	003	0	1	01	01	H1463_003_0	5	Non-Preferred Drug	4	100100	1	1	4	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	003	0	1	01	01	H1463_003_0	5	Specialty Tier	4	010010	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	009	0	1	01	01	H1463_009_0	5	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	22.50					0.00	0.00	0.00					9.00	18.00	22.50																9.00				9.00			0.30	0.00	0.30			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	009	0	1	01	01	H1463_009_0	5	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	50.00					20.00	40.00	40.00					20.00	40.00	50.00																20.00				20.00			0.67	0.67	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	009	0	1	01	01	H1463_009_0	5	Preferred Brand	4	000001	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	117.50					47.00	94.00	94.00					47.00	94.00	117.50																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	009	0	1	01	01	H1463_009_0	5	Non-Preferred Drug	4	100100	1	1	4	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	009	0	1	01	01	H1463_009_0	5	Specialty Tier	4	010010	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	010	0	1	01	01	H1463_010_0	5	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	22.50					0.00	0.00	0.00					9.00	18.00	22.50																9.00				9.00			0.30	0.00	0.30			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	010	0	1	01	01	H1463_010_0	5	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	50.00					20.00	40.00	40.00					20.00	40.00	50.00																20.00				20.00			0.67	0.67	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	010	0	1	01	01	H1463_010_0	5	Preferred Brand	4	000001	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	117.50					47.00	94.00	94.00					47.00	94.00	117.50																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	010	0	1	01	01	H1463_010_0	5	Non-Preferred Drug	4	100100	1	1	4	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	010	0	1	01	01	H1463_010_0	5	Specialty Tier	4	010010	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	012	0	1	01	01	H1463_012_0	7	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	22.50					0.00	0.00	0.00					9.00	18.00	22.50																9.00				9.00			0.30	0.00	0.30			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	012	0	1	01	01	H1463_012_0	7	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	50.00					20.00	40.00	40.00					20.00	40.00	50.00																20.00				20.00			0.67	0.67	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	012	0	1	01	01	H1463_012_0	7	Preferred Brand	4	000001	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	117.50					47.00	94.00	94.00					47.00	94.00	117.50																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	012	0	1	01	01	H1463_012_0	7	Non-Preferred Drug	4	100100	1	1	4	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	012	0	1	01	01	H1463_012_0	7	Specialty Tier	4	010010	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	013	0	1	01	01	H1463_013_0	7	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	22.50					0.00	0.00	0.00					9.00	18.00	22.50																9.00				9.00			0.30	0.00	0.30			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	013	0	1	01	01	H1463_013_0	7	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	50.00					20.00	40.00	40.00					20.00	40.00	50.00																20.00				20.00			0.67	0.67	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	013	0	1	01	01	H1463_013_0	7	Preferred Brand	4	000001	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	117.50					47.00	94.00	94.00					47.00	94.00	117.50																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	013	0	1	01	01	H1463_013_0	7	Non-Preferred Drug	4	100100	1	1	4	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	013	0	1	01	01	H1463_013_0	7	Specialty Tier	4	010010	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	015	0	1	02	01	H1463_015_0	6	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	22.50					0.00	0.00	0.00					9.00	18.00	22.50																9.00				9.00			0.30	0.00	0.30			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	015	0	1	02	01	H1463_015_0	6	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	50.00					20.00	40.00	40.00					20.00	40.00	50.00																20.00				20.00			0.67	0.67	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	015	0	1	02	01	H1463_015_0	6	Preferred Brand	4	000001	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	117.50					47.00	94.00	94.00					47.00	94.00	117.50																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	015	0	1	02	01	H1463_015_0	6	Non-Preferred Drug	4	100100	1	1	4	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	015	0	1	02	01	H1463_015_0	6	Specialty Tier	4	010010	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	017	0	1	02	01	H1463_017_0	6	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	22.50					0.00	0.00	0.00					9.00	18.00	22.50																9.00				9.00			0.30	0.00	0.30			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	017	0	1	02	01	H1463_017_0	6	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	50.00					20.00	40.00	40.00					20.00	40.00	50.00																20.00				20.00			0.67	0.67	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	017	0	1	02	01	H1463_017_0	6	Preferred Brand	4	000001	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	117.50					47.00	94.00	94.00					47.00	94.00	117.50																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	017	0	1	02	01	H1463_017_0	6	Non-Preferred Drug	4	100100	1	1	4	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	017	0	1	02	01	H1463_017_0	6	Specialty Tier	4	010010	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	019	0	1	02	01	H1463_019_0	6	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	22.50					0.00	0.00	0.00					9.00	18.00	22.50																9.00				9.00			0.30	0.00	0.30			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	019	0	1	02	01	H1463_019_0	6	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	50.00					20.00	40.00	40.00					20.00	40.00	50.00																20.00				20.00			0.67	0.67	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	019	0	1	02	01	H1463_019_0	6	Preferred Brand	4	000001	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	117.50					47.00	94.00	94.00					47.00	94.00	117.50																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	019	0	1	02	01	H1463_019_0	6	Non-Preferred Drug	4	100100	1	1	4	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1463	019	0	1	02	01	H1463_019_0	6	Specialty Tier	4	010010	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1468	007	0	1	01	01	H1468_007_0	5	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1468	007	0	1	01	01	H1468_007_0	5	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1468	007	0	1	01	01	H1468_007_0	5	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1468	007	0	1	01	01	H1468_007_0	5	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1468	007	0	1	01	01	H1468_007_0	5	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1468	007	0	1	01	01	H1468_007_0	5	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1468	007	0	1	01	01	H1468_007_0	5	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1468	007	0	1	01	01	H1468_007_0	5	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1468	007	0	1	01	01	H1468_007_0	5	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1468	007	0	1	01	01	H1468_007_0	5	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1493	001	0	1	01	01	H1493_001_0	6	Preferred Generic	4	001001	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	4.00		12.00																					10.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1493	001	0	1	01	01	H1493_001_0	6	Generic	4	010001	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	10.00		30.00																					25.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1493	001	0	1	01	01	H1493_001_0	6	Preferred Brand	4	000101	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		141.00																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1493	001	0	1	01	01	H1493_001_0	6	Non-Preferred Drug	4	100100	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		300.00																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1493	001	0	1	01	01	H1493_001_0	6	Specialty Tier	4	010010	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31					33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1493	002	0	1	01	01	H1493_002_0	5	Preferred Generic	4	001001	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												
H1493	002	0	1	01	01	H1493_002_0	5	Generic	4	010001	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	10.00		30.00																					25.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1493	002	0	1	01	01	H1493_002_0	5	Preferred Brand	4	000101	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		141.00																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1493	002	0	1	01	01	H1493_002_0	5	Non-Preferred Drug	4	100100	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		300.00																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1493	002	0	1	01	01	H1493_002_0	5	Specialty Tier	4	010010	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31					33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1493	004	0	1	01	01	H1493_004_0	4	Preferred Generic	4	001001	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	6.00		18.00																					15.00																6.00				6.00		0.20						0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1493	004	0	1	01	01	H1493_004_0	4	Generic	4	010001	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	15.00		45.00																					37.50																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1493	004	0	1	01	01	H1493_004_0	4	Preferred Brand	4	000101	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		141.00																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1493	004	0	1	01	01	H1493_004_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		300.00																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1493	004	0	1	01	01	H1493_004_0	4	Specialty Tier	4	010010	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31					28		28																				28															28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1510	001	0	1	04	01	H1510_001_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1510	001	0	1	04	01	H1510_001_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1510	001	0	1	04	01	H1510_001_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1510	001	0	1	04	01	H1510_001_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1510	001	0	1	04	01	H1510_001_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1510	001	0	1	04	01	H1510_001_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1510	001	0	1	04	01	H1510_001_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1510	001	0	1	04	01	H1510_001_0	4	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1510	001	0	1	04	01	H1510_001_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1510	001	0	1	04	01	H1510_001_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1510	004	0	1	04	01	H1510_004_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1510	004	0	1	04	01	H1510_004_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1510	004	0	1	04	01	H1510_004_0	3	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1510	004	0	1	04	01	H1510_004_0	3	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1510	004	0	1	04	01	H1510_004_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1510	004	0	1	04	01	H1510_004_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1510	004	0	1	04	01	H1510_004_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1510	004	0	1	04	01	H1510_004_0	3	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1510	004	0	1	04	01	H1510_004_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1510	004	0	1	04	01	H1510_004_0	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1510	005	0	1	04	01	H1510_005_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1510	005	0	1	04	01	H1510_005_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1510	005	0	1	04	01	H1510_005_0	3	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1510	005	0	1	04	01	H1510_005_0	3	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1510	005	0	1	04	01	H1510_005_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1510	005	0	1	04	01	H1510_005_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1510	005	0	1	04	01	H1510_005_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1510	005	0	1	04	01	H1510_005_0	3	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1510	005	0	1	04	01	H1510_005_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1510	005	0	1	04	01	H1510_005_0	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1517	007	0	1	04	01	H1517_007_0	7	Preferred Generic	4	001000	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												
H1517	007	0	1	04	01	H1517_007_0	7	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								18.00	36.00	54.00					13.00	26.00	39.00					13.00	39.00	39.00																18.00				18.00			0.60	0.43	0.43			0.53	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1517	007	0	1	04	01	H1517_007_0	7	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	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												
H1517	007	0	1	04	01	H1517_007_0	7	Non-Preferred Drug	4	100100	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								97.00	194.00	291.00					92.00	184.00	276.00					92.00	276.00	276.00																97.00				97.00			3.23	3.07	3.07			2.85	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1517	007	0	1	04	01	H1517_007_0	7	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1517	007	0	1	04	01	H1517_007_0	7	Select Care Drugs	4	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1517	007	0	1	04	01	H1517_007_0	7	Select Care Drugs	4	001000	1	2	6	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		
H1537	001	0	1	04	01	H1537_001_0	6	Preferred Generic	3	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1537	001	0	1	04	01	H1537_001_0	6	Generic	3	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1537	001	0	1	04	01	H1537_001_0	6	Preferred Brand	3	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1537	001	0	1	04	01	H1537_001_0	6	Non-Preferred Drug	3	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1537	001	0	1	04	01	H1537_001_0	6	Specialty Tier	3	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				557.00	26		26																										26						26			26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1607	012	0	1	04	01	H1607_012_0	7	Preferred Generic	4	001000	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												
H1607	012	0	1	04	01	H1607_012_0	7	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					12.00	24.00	36.00					12.00	36.00	36.00																17.00				17.00			0.57	0.40	0.40			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1607	012	0	1	04	01	H1607_012_0	7	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	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												
H1607	012	0	1	04	01	H1607_012_0	7	Non-Preferred Drug	4	100100	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												
H1607	012	0	1	04	01	H1607_012_0	7	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1607	012	0	1	04	01	H1607_012_0	7	Select Care Drugs	4	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1607	012	0	1	04	01	H1607_012_0	7	Select Care Drugs	4	001000	1	2	6	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		
H1608	001	0	1	04	01	H1608_001_0	4	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	001	0	1	04	01	H1608_001_0	4	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	001	0	1	04	01	H1608_001_0	4	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	001	0	1	04	01	H1608_001_0	4	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	001	0	1	04	01	H1608_001_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	001	0	1	04	01	H1608_001_0	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	001	0	1	04	01	H1608_001_0	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	004	0	1	04	01	H1608_004_0	4	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	004	0	1	04	01	H1608_004_0	4	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	004	0	1	04	01	H1608_004_0	4	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	004	0	1	04	01	H1608_004_0	4	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	004	0	1	04	01	H1608_004_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	004	0	1	04	01	H1608_004_0	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	004	0	1	04	01	H1608_004_0	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	007	0	1	04	01	H1608_007_0	4	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	007	0	1	04	01	H1608_007_0	4	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	007	0	1	04	01	H1608_007_0	4	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	007	0	1	04	01	H1608_007_0	4	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	007	0	1	04	01	H1608_007_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	007	0	1	04	01	H1608_007_0	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	007	0	1	04	01	H1608_007_0	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	008	0	1	04	01	H1608_008_0	4	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	008	0	1	04	01	H1608_008_0	4	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	008	0	1	04	01	H1608_008_0	4	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	008	0	1	04	01	H1608_008_0	4	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	008	0	1	04	01	H1608_008_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	008	0	1	04	01	H1608_008_0	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	008	0	1	04	01	H1608_008_0	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	012	0	1	04	01	H1608_012_0	4	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	012	0	1	04	01	H1608_012_0	4	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	012	0	1	04	01	H1608_012_0	4	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	012	0	1	04	01	H1608_012_0	4	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	012	0	1	04	01	H1608_012_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	27						1.00	27												27						27						27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	013	0	1	04	01	H1608_013_0	4	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	013	0	1	04	01	H1608_013_0	4	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	013	0	1	04	01	H1608_013_0	4	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	013	0	1	04	01	H1608_013_0	4	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	013	0	1	04	01	H1608_013_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	016	0	1	04	01	H1608_016_0	5	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	016	0	1	04	01	H1608_016_0	5	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	016	0	1	04	01	H1608_016_0	5	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	016	0	1	04	01	H1608_016_0	5	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	016	0	1	04	01	H1608_016_0	5	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	5	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	5	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	017	0	1	04	01	H1608_017_0	4	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	017	0	1	04	01	H1608_017_0	4	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	017	0	1	04	01	H1608_017_0	4	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	017	0	1	04	01	H1608_017_0	4	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	017	0	1	04	01	H1608_017_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	017	0	1	04	01	H1608_017_0	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	017	0	1	04	01	H1608_017_0	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	018	0	1	04	01	H1608_018_0	4	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	018	0	1	04	01	H1608_018_0	4	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	018	0	1	04	01	H1608_018_0	4	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	018	0	1	04	01	H1608_018_0	4	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	018	0	1	04	01	H1608_018_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	021	0	1	04	01	H1608_021_0	4	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	021	0	1	04	01	H1608_021_0	4	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	021	0	1	04	01	H1608_021_0	4	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	021	0	1	04	01	H1608_021_0	4	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	021	0	1	04	01	H1608_021_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	023	0	1	04	01	H1608_023_0	4	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	023	0	1	04	01	H1608_023_0	4	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	023	0	1	04	01	H1608_023_0	4	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	023	0	1	04	01	H1608_023_0	4	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	023	0	1	04	01	H1608_023_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	023	0	1	04	01	H1608_023_0	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	023	0	1	04	01	H1608_023_0	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	024	0	1	04	01	H1608_024_0	4	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	024	0	1	04	01	H1608_024_0	4	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	024	0	1	04	01	H1608_024_0	4	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	024	0	1	04	01	H1608_024_0	4	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	024	0	1	04	01	H1608_024_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	025	0	1	04	01	H1608_025_0	5	Preferred Generic	4	001010	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	025	0	1	04	01	H1608_025_0	5	Preferred Generic	4	001010	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	025	0	1	04	01	H1608_025_0	5	Generic	4	010010	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	025	0	1	04	01	H1608_025_0	5	Generic	4	010010	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	025	0	1	04	01	H1608_025_0	5	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	025	0	1	04	01	H1608_025_0	5	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	025	0	1	04	01	H1608_025_0	5	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	026	0	1	04	01	H1608_026_0	4	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	026	0	1	04	01	H1608_026_0	4	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	026	0	1	04	01	H1608_026_0	4	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	026	0	1	04	01	H1608_026_0	4	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	026	0	1	04	01	H1608_026_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	28						1.00	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	027	0	1	04	01	H1608_027_0	4	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	027	0	1	04	01	H1608_027_0	4	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	027	0	1	04	01	H1608_027_0	4	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	027	0	1	04	01	H1608_027_0	4	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	027	0	1	04	01	H1608_027_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	28						1.00	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	028	0	1	04	01	H1608_028_0	5	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	028	0	1	04	01	H1608_028_0	5	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	028	0	1	04	01	H1608_028_0	5	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	028	0	1	04	01	H1608_028_0	5	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	028	0	1	04	01	H1608_028_0	5	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	028	0	1	04	01	H1608_028_0	5	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	028	0	1	04	01	H1608_028_0	5	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	31						1.00	31												31						31						31		31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	029	0	1	04	01	H1608_029_0	5	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	029	0	1	04	01	H1608_029_0	5	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	029	0	1	04	01	H1608_029_0	5	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	029	0	1	04	01	H1608_029_0	5	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	029	0	1	04	01	H1608_029_0	5	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	5	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	5	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	30						1.00	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	031	0	1	04	01	H1608_031_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	031	0	1	04	01	H1608_031_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	031	0	1	04	01	H1608_031_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1608	031	0	1	04	01	H1608_031_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1608	031	0	1	04	01	H1608_031_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	3	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	001	0	1	01	01	H1609_001_0	4	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	001	0	1	01	01	H1609_001_0	4	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1609	001	0	1	01	01	H1609_001_0	4	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	001	0	1	01	01	H1609_001_0	4	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1609	001	0	1	01	01	H1609_001_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	001	0	1	01	01	H1609_001_0	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	001	0	1	01	01	H1609_001_0	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	009	0	1	01	01	H1609_009_0	4	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	009	0	1	01	01	H1609_009_0	4	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1609	009	0	1	01	01	H1609_009_0	4	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	009	0	1	01	01	H1609_009_0	4	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1609	009	0	1	01	01	H1609_009_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	009	0	1	01	01	H1609_009_0	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	009	0	1	01	01	H1609_009_0	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	014	0	1	01	01	H1609_014_0	6	Preferred Generic	4	001010	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												
H1609	014	0	1	01	01	H1609_014_0	6	Preferred Generic	4	001010	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
H1609	014	0	1	01	01	H1609_014_0	6	Generic	4	010010	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	014	0	1	01	01	H1609_014_0	6	Generic	4	010010	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1609	014	0	1	01	01	H1609_014_0	6	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					3.00	6.00	9.00											47.00	94.00	141.00				3.00	6.00	9.00					47.00			47.00			1.57	0.10		1.57	0.10	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	014	0	1	01	01	H1609_014_0	6	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	014	0	1	01	01	H1609_014_0	6	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	015	0	1	01	01	H1609_015_0	6	Preferred Generic	4	001010	3	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	015	0	1	01	01	H1609_015_0	6	Preferred Generic	4	001010	3	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1609	015	0	1	01	01	H1609_015_0	6	Generic	4	010010	3	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	015	0	1	01	01	H1609_015_0	6	Generic	4	010010	3	2	2	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1609	015	0	1	01	01	H1609_015_0	6	Preferred Brand	4	010001	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47.00	94.00	141.00																			47.00	94.00	141.00																	47.00			47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	015	0	1	01	01	H1609_015_0	6	Non-Preferred Drug	4	100100	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	015	0	1	01	01	H1609_015_0	6	Specialty Tier	4	010010	1	1	5	1	010		10	010		1	30								30							10	31				1.00	33																				33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	016	0	1	01	01	H1609_016_0	5	Preferred Generic	4	001010	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												
H1609	016	0	1	01	01	H1609_016_0	5	Preferred Generic	4	001010	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
H1609	016	0	1	01	01	H1609_016_0	5	Generic	4	010010	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	016	0	1	01	01	H1609_016_0	5	Generic	4	010010	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1609	016	0	1	01	01	H1609_016_0	5	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					3.00	6.00	9.00											47.00	94.00	141.00				3.00	6.00	9.00					47.00			47.00			1.57	0.10		1.57	0.10	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	016	0	1	01	01	H1609_016_0	5	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	016	0	1	01	01	H1609_016_0	5	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	017	0	1	01	01	H1609_017_0	5	Preferred Generic	4	001010	3	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	017	0	1	01	01	H1609_017_0	5	Preferred Generic	4	001010	3	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1609	017	0	1	01	01	H1609_017_0	5	Generic	4	010010	3	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	017	0	1	01	01	H1609_017_0	5	Generic	4	010010	3	2	2	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1609	017	0	1	01	01	H1609_017_0	5	Preferred Brand	4	010001	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47.00	94.00	141.00																			47.00	94.00	141.00																	47.00			47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	017	0	1	01	01	H1609_017_0	5	Non-Preferred Drug	4	100100	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	017	0	1	01	01	H1609_017_0	5	Specialty Tier	4	010010	1	1	5	1	010		10	010		1	30								30							10	31				1.00	33																				33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	018	0	1	01	01	H1609_018_0	5	Preferred Generic	4	001010	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												
H1609	018	0	1	01	01	H1609_018_0	5	Preferred Generic	4	001010	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
H1609	018	0	1	01	01	H1609_018_0	5	Generic	4	010010	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	018	0	1	01	01	H1609_018_0	5	Generic	4	010010	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1609	018	0	1	01	01	H1609_018_0	5	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					3.00	6.00	9.00											47.00	94.00	141.00				3.00	6.00	9.00					47.00			47.00			1.57	0.10		1.57	0.10	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	018	0	1	01	01	H1609_018_0	5	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	018	0	1	01	01	H1609_018_0	5	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	019	0	1	01	01	H1609_019_0	5	Preferred Generic	4	001010	3	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	019	0	1	01	01	H1609_019_0	5	Preferred Generic	4	001010	3	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1609	019	0	1	01	01	H1609_019_0	5	Generic	4	010010	3	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	019	0	1	01	01	H1609_019_0	5	Generic	4	010010	3	2	2	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1609	019	0	1	01	01	H1609_019_0	5	Preferred Brand	4	010001	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47.00	94.00	141.00																			47.00	94.00	141.00																	47.00			47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	019	0	1	01	01	H1609_019_0	5	Non-Preferred Drug	4	100100	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	019	0	1	01	01	H1609_019_0	5	Specialty Tier	4	010010	1	1	5	1	010		10	010		1	30								30							10	31				1.00	33																				33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	020	0	1	01	01	H1609_020_0	6	Preferred Generic	4	001010	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												
H1609	020	0	1	01	01	H1609_020_0	6	Preferred Generic	4	001010	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
H1609	020	0	1	01	01	H1609_020_0	6	Generic	4	010010	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	020	0	1	01	01	H1609_020_0	6	Generic	4	010010	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1609	020	0	1	01	01	H1609_020_0	6	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	020	0	1	01	01	H1609_020_0	6	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	020	0	1	01	01	H1609_020_0	6	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	021	0	1	01	01	H1609_021_0	4	Preferred Generic	4	001010	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												
H1609	021	0	1	01	01	H1609_021_0	4	Preferred Generic	4	001010	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
H1609	021	0	1	01	01	H1609_021_0	4	Generic	4	010010	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	021	0	1	01	01	H1609_021_0	4	Generic	4	010010	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1609	021	0	1	01	01	H1609_021_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	021	0	1	01	01	H1609_021_0	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	021	0	1	01	01	H1609_021_0	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	022	0	1	01	01	H1609_022_0	4	Preferred Generic	4	001010	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												
H1609	022	0	1	01	01	H1609_022_0	4	Preferred Generic	4	001010	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
H1609	022	0	1	01	01	H1609_022_0	4	Generic	4	010010	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	022	0	1	01	01	H1609_022_0	4	Generic	4	010010	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1609	022	0	1	01	01	H1609_022_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	022	0	1	01	01	H1609_022_0	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	022	0	1	01	01	H1609_022_0	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	023	0	1	01	01	H1609_023_0	5	Preferred Generic	4	001010	3	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	023	0	1	01	01	H1609_023_0	5	Preferred Generic	4	001010	3	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1609	023	0	1	01	01	H1609_023_0	5	Generic	4	010010	3	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	023	0	1	01	01	H1609_023_0	5	Generic	4	010010	3	2	2	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1609	023	0	1	01	01	H1609_023_0	5	Preferred Brand	4	010001	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	47.00	94.00	141.00																			47.00	94.00	141.00																	47.00			47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	023	0	1	01	01	H1609_023_0	5	Non-Preferred Drug	4	100100	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	023	0	1	01	01	H1609_023_0	5	Specialty Tier	4	010010	1	1	5	1	010		10	010		1	30								30							10	31				1.00	33																				33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	024	0	1	01	01	H1609_024_0	3	Preferred Generic	4	001010	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												
H1609	024	0	1	01	01	H1609_024_0	3	Preferred Generic	4	001010	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
H1609	024	0	1	01	01	H1609_024_0	3	Generic	4	010010	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	024	0	1	01	01	H1609_024_0	3	Generic	4	010010	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1609	024	0	1	01	01	H1609_024_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	024	0	1	01	01	H1609_024_0	3	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	024	0	1	01	01	H1609_024_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	025	0	1	01	01	H1609_025_0	3	Preferred Generic	4	001010	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												
H1609	025	0	1	01	01	H1609_025_0	3	Preferred Generic	4	001010	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
H1609	025	0	1	01	01	H1609_025_0	3	Generic	4	010010	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	025	0	1	01	01	H1609_025_0	3	Generic	4	010010	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1609	025	0	1	01	01	H1609_025_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	025	0	1	01	01	H1609_025_0	3	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	025	0	1	01	01	H1609_025_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	026	0	1	01	01	H1609_026_0	4	Preferred Generic	4	001010	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	026	0	1	01	01	H1609_026_0	4	Preferred Generic	4	001010	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1609	026	0	1	01	01	H1609_026_0	4	Generic	4	010010	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	026	0	1	01	01	H1609_026_0	4	Generic	4	010010	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1609	026	0	1	01	01	H1609_026_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	026	0	1	01	01	H1609_026_0	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	026	0	1	01	01	H1609_026_0	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	027	0	1	01	01	H1609_027_0	3	Preferred Generic	4	001010	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												
H1609	027	0	1	01	01	H1609_027_0	3	Preferred Generic	4	001010	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
H1609	027	0	1	01	01	H1609_027_0	3	Generic	4	010010	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	027	0	1	01	01	H1609_027_0	3	Generic	4	010010	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H1609	027	0	1	01	01	H1609_027_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	027	0	1	01	01	H1609_027_0	3	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1609	027	0	1	01	01	H1609_027_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1659	001	0	1	04	01	H1659_001_0	10	Preferred Generic	4	001000	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	6.00		18.00																									6.00		15.00				6.00		0.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1659	001	0	1	04	01	H1659_001_0	10	Generic	4	010000	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	18.00		54.00																									18.00		45.00				18.00		45.00				18.00				18.00		0.60				0.60	0.60	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1659	001	0	1	04	01	H1659_001_0	10	Preferred Brand	4	000001	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	40.00		120.00																									40.00		100.00				40.00		100.00				40.00				40.00		1.33				1.33	1.33	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1659	001	0	1	04	01	H1659_001_0	10	Non-Preferred Drug	4	100000	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	90.00		270.00																									90.00		225.00				90.00		225.00				90.00				90.00		3.00				3.00	3.00	2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1659	001	0	1	04	01	H1659_001_0	10	Specialty Tier	4	110001	1	1	5	1	110		01		110	1	30		90				1	2				30		90	30		31				275.00	25		25																								25		25				25		25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1659	002	0	1	04	01	H1659_002_0	10	Preferred Generic	4	001000	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	8.00		24.00																									8.00		20.00				8.00		0.00				8.00				8.00		0.27				0.27	0.27	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1659	002	0	1	04	01	H1659_002_0	10	Generic	4	010000	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	18.00		54.00																									18.00		45.00				18.00		45.00				18.00				18.00		0.60				0.60	0.60	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1659	002	0	1	04	01	H1659_002_0	10	Preferred Brand	4	000001	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	45.00		135.00																									45.00		112.50				45.00		112.50				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1659	002	0	1	04	01	H1659_002_0	10	Non-Preferred Drug	4	100000	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	95.00		285.00																									95.00		237.50				95.00		237.50				95.00				95.00		3.17				3.17	3.17	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1659	002	0	1	04	01	H1659_002_0	10	Specialty Tier	4	110001	1	1	5	1	110		01		110	1	30		90				1	2				30		90	30		31				275.00	25		25																								25		25				25		25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1659	003	0	1	04	01	H1659_003_0	10	Preferred Generic	4	001000	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	10.00		30.00																									10.00		25.00				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												
H1659	003	0	1	04	01	H1659_003_0	10	Generic	4	010000	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		50.00				20.00		50.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1659	003	0	1	04	01	H1659_003_0	10	Preferred Brand	4	000001	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		117.50				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												
H1659	003	0	1	04	01	H1659_003_0	10	Non-Preferred Drug	4	100000	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		250.00				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												
H1659	003	0	1	04	01	H1659_003_0	10	Specialty Tier	4	110001	1	1	5	1	110		01		110	1	30		90				1	2				30		90	30		31				275.00	25		25																								25		25				25		25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1660	001	0	1	01	01	H1660_001_0	8	Preferred Generic	4	001000	3	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	001	0	1	01	01	H1660_001_0	8	Preferred Generic	4	001000	3	2	1	3	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H1660	001	0	1	01	01	H1660_001_0	8	Generic	4	010000	3	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	001	0	1	01	01	H1660_001_0	8	Preferred Brand	4	000001	3	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					94.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	001	0	1	01	01	H1660_001_0	8	Non-Preferred Brand	4	100100	3	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	001	0	1	01	01	H1660_001_0	8	Specialty Tier	4	010010	1	1	5	1	111		01	010		1	30	60	90				1	1	30						30		31				300.00	33	33	33																		33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	005	0	1	01	01	H1660_005_0	8	Preferred Generic	4	001000	3	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	005	0	1	01	01	H1660_005_0	8	Preferred Generic	4	001000	3	2	1	3	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H1660	005	0	1	01	01	H1660_005_0	8	Generic	4	010000	3	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	005	0	1	01	01	H1660_005_0	8	Preferred Brand	4	000001	3	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					94.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	005	0	1	01	01	H1660_005_0	8	Non-Preferred Brand	4	100100	3	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	005	0	1	01	01	H1660_005_0	8	Specialty Tier	4	010010	1	1	5	1	111		01	010		1	30	60	90				1	1	30						30		31				300.00	33	33	33																		33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	009	0	1	01	01	H1660_009_0	8	Preferred Generic	4	001000	3	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	009	0	1	01	01	H1660_009_0	8	Generic	4	010000	3	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	009	0	1	01	01	H1660_009_0	8	Preferred Brand	4	000001	3	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					94.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	009	0	1	01	01	H1660_009_0	8	Non-Preferred Brand	4	100100	3	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	009	0	1	01	01	H1660_009_0	8	Specialty Tier	4	010010	1	1	5	1	111		01	010		1	30	60	90				1	1	30						30		31				300.00	26	26	26																		26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	012	0	1	01	01	H1660_012_0	8	Preferred Generic	4	001000	3	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	012	0	1	01	01	H1660_012_0	8	Generic	4	010000	3	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	012	0	1	01	01	H1660_012_0	8	Preferred Brand	4	000001	3	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					94.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	012	0	1	01	01	H1660_012_0	8	Non-Preferred Brand	4	100100	3	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	012	0	1	01	01	H1660_012_0	8	Specialty Tier	4	010010	1	1	5	1	111		01	010		1	30	60	90				1	1	30						30		31				300.00	26	26	26																		26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	013	0	1	01	01	H1660_013_0	12	Preferred Generic	4	001000	3	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	013	0	1	01	01	H1660_013_0	12	Generic	4	010000	3	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	013	0	1	01	01	H1660_013_0	12	Preferred Brand	4	000001	3	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					94.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	013	0	1	01	01	H1660_013_0	12	Non-Preferred Brand	4	100100	3	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1660	013	0	1	01	01	H1660_013_0	12	Specialty Tier	4	010010	1	1	5	1	111		01	010		1	30	60	90				1	1	30						30		31				300.00	28	28	28																		28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	001	0	1	04	01	H1666_001_0	5	Preferred Generic	4	001000	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							27.00																9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	001	0	1	04	01	H1666_001_0	5	Preferred Generic	4	001000	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							27.00																9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1666	001	0	1	04	01	H1666_001_0	5	Generic	4	010010	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		60.00					9.00		27.00							60.00																20.00				20.00			0.67	0.30				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	001	0	1	04	01	H1666_001_0	5	Generic	4	010010	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								20.00		60.00					9.00		27.00							60.00																20.00				20.00			0.67	0.30				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1666	001	0	1	04	01	H1666_001_0	5	Preferred Brand	4	010001	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					39.00		117.00							141.00																47.00				47.00			1.57	1.30				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	001	0	1	04	01	H1666_001_0	5	Non-Preferred Brand	4	110000	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								100.00		300.00					95.00		285.00							300.00																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	001	0	1	04	01	H1666_001_0	5	Specialty Tier	4	010010	1	1	5	1		110	01	100		1				30		90	1	2			90				30		31											575.09	33		33				628.51	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	002	0	1	04	01	H1666_002_0	5	Preferred Generic	4	001000	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							27.00																9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	002	0	1	04	01	H1666_002_0	5	Preferred Generic	4	001000	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							27.00																9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1666	002	0	1	04	01	H1666_002_0	5	Generic	4	010010	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		60.00					9.00		27.00							60.00																20.00				20.00			0.67	0.30				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	002	0	1	04	01	H1666_002_0	5	Generic	4	010010	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								20.00		60.00					9.00		27.00							60.00																20.00				20.00			0.67	0.30				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1666	002	0	1	04	01	H1666_002_0	5	Preferred Brand	4	010001	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					39.00		117.00							141.00																47.00				47.00			1.57	1.30				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	002	0	1	04	01	H1666_002_0	5	Non-Preferred Brand	4	110000	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								100.00		300.00					95.00		285.00							300.00																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	002	0	1	04	01	H1666_002_0	5	Specialty Tier	4	010010	1	1	5	1		110	01	100		1				30		90	1	2			90				30		31											548.03	33		33				549.78	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	003	0	1	04	01	H1666_003_0	5	Preferred Generic	4	001000	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							27.00																9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	003	0	1	04	01	H1666_003_0	5	Preferred Generic	4	001000	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							27.00																9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1666	003	0	1	04	01	H1666_003_0	5	Generic	4	010010	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		60.00					9.00		27.00							60.00																20.00				20.00			0.67	0.30				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	003	0	1	04	01	H1666_003_0	5	Generic	4	010010	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								20.00		60.00					9.00		27.00							60.00																20.00				20.00			0.67	0.30				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1666	003	0	1	04	01	H1666_003_0	5	Preferred Brand	4	010001	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					39.00		117.00							141.00																47.00				47.00			1.57	1.30				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	003	0	1	04	01	H1666_003_0	5	Non-Preferred Brand	4	110000	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								100.00		300.00					95.00		285.00							300.00																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	003	0	1	04	01	H1666_003_0	5	Specialty Tier	4	010010	1	1	5	1		110	01	100		1				30		90	1	2			90				30		31											644.85	33		33				632.14	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	004	0	1	04	01	H1666_004_0	5	Preferred Generic	4	001000	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							27.00																9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	004	0	1	04	01	H1666_004_0	5	Preferred Generic	4	001000	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							27.00																9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1666	004	0	1	04	01	H1666_004_0	5	Generic	4	010010	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		60.00					9.00		27.00							60.00																20.00				20.00			0.67	0.30				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	004	0	1	04	01	H1666_004_0	5	Generic	4	010010	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								20.00		60.00					9.00		27.00							60.00																20.00				20.00			0.67	0.30				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1666	004	0	1	04	01	H1666_004_0	5	Preferred Brand	4	010001	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					39.00		117.00							141.00																47.00				47.00			1.57	1.30				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	004	0	1	04	01	H1666_004_0	5	Non-Preferred Brand	4	110000	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								100.00		300.00					95.00		285.00							300.00																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	004	0	1	04	01	H1666_004_0	5	Specialty Tier	4	010010	1	1	5	1		110	01	100		1				30		90	1	2			90				30		31											742.45	33		33				732.21	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	005	0	1	04	01	H1666_005_0	4	Preferred Generic	4	001000	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							27.00																9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	005	0	1	04	01	H1666_005_0	4	Preferred Generic	4	001000	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							27.00																9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1666	005	0	1	04	01	H1666_005_0	4	Generic	4	010010	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		60.00					9.00		27.00							60.00																20.00				20.00			0.67	0.30				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	005	0	1	04	01	H1666_005_0	4	Generic	4	010010	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								20.00		60.00					9.00		27.00							60.00																20.00				20.00			0.67	0.30				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1666	005	0	1	04	01	H1666_005_0	4	Preferred Brand	4	010001	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					39.00		117.00							141.00																47.00				47.00			1.57	1.30				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	005	0	1	04	01	H1666_005_0	4	Non-Preferred Brand	4	110000	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								100.00		300.00					95.00		285.00							300.00																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	005	0	1	04	01	H1666_005_0	4	Specialty Tier	4	010010	1	1	5	1		110	01	100		1				30		90	1	2			90				30		31											504.87	33		33				532.68	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	006	0	1	04	01	H1666_006_0	4	Preferred Generic	4	001000	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							27.00																9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	006	0	1	04	01	H1666_006_0	4	Preferred Generic	4	001000	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							27.00																9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1666	006	0	1	04	01	H1666_006_0	4	Generic	4	010010	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		60.00					9.00		27.00							60.00																20.00				20.00			0.67	0.30				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	006	0	1	04	01	H1666_006_0	4	Generic	4	010010	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								20.00		60.00					9.00		27.00							60.00																20.00				20.00			0.67	0.30				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1666	006	0	1	04	01	H1666_006_0	4	Preferred Brand	4	010001	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					39.00		117.00							141.00																47.00				47.00			1.57	1.30				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	006	0	1	04	01	H1666_006_0	4	Non-Preferred Brand	4	110000	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								100.00		300.00					95.00		285.00							300.00																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	006	0	1	04	01	H1666_006_0	4	Specialty Tier	4	010010	1	1	5	1		110	01	100		1				30		90	1	2			90				30		31											826.96	33		33				832.88	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	008	0	1	04	01	H1666_008_0	5	Preferred Generic	4	001000	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							27.00																9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	008	0	1	04	01	H1666_008_0	5	Preferred Generic	4	001000	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							27.00																9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1666	008	0	1	04	01	H1666_008_0	5	Generic	4	010010	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		60.00					9.00		27.00							60.00																20.00				20.00			0.67	0.30				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	008	0	1	04	01	H1666_008_0	5	Generic	4	010010	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								20.00		60.00					9.00		27.00							60.00																20.00				20.00			0.67	0.30				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1666	008	0	1	04	01	H1666_008_0	5	Preferred Brand	4	010001	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					39.00		117.00							141.00																47.00				47.00			1.57	1.30				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	008	0	1	04	01	H1666_008_0	5	Non-Preferred Brand	4	110000	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								100.00		300.00					95.00		285.00							300.00																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	008	0	1	04	01	H1666_008_0	5	Specialty Tier	4	010010	1	1	5	1		110	01	100		1				30		90	1	2			90				30		31											682.15	33		33				681.41	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	009	0	1	04	01	H1666_009_0	5	Preferred Generic	4	001000	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							27.00																9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	009	0	1	04	01	H1666_009_0	5	Preferred Generic	4	001000	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							27.00																9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1666	009	0	1	04	01	H1666_009_0	5	Generic	4	010010	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		60.00					9.00		27.00							60.00																20.00				20.00			0.67	0.30				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	009	0	1	04	01	H1666_009_0	5	Generic	4	010010	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								20.00		60.00					9.00		27.00							60.00																20.00				20.00			0.67	0.30				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1666	009	0	1	04	01	H1666_009_0	5	Preferred Brand	4	010001	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					39.00		117.00							141.00																47.00				47.00			1.57	1.30				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	009	0	1	04	01	H1666_009_0	5	Non-Preferred Brand	4	110000	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								100.00		300.00					95.00		285.00							300.00																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1666	009	0	1	04	01	H1666_009_0	5	Specialty Tier	4	010010	1	1	5	1		110	01	100		1				30		90	1	2			90				30		31											681.74	33		33				680.99	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1692	002	0	1	01	01	H1692_002_0	4	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1692	002	0	1	01	01	H1692_002_0	4	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1692	002	0	1	01	01	H1692_002_0	4	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1692	002	0	1	01	01	H1692_002_0	4	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1692	002	0	1	01	01	H1692_002_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1692	002	0	1	01	01	H1692_002_0	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1692	002	0	1	01	01	H1692_002_0	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	30						1.00	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1692	003	0	1	01	01	H1692_003_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1692	003	0	1	01	01	H1692_003_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1692	003	0	1	01	01	H1692_003_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1692	003	0	1	01	01	H1692_003_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1692	003	0	1	01	01	H1692_003_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1692	003	0	1	01	01	H1692_003_0	3	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1692	003	0	1	01	01	H1692_003_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	27						1.00	27												27						27						27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1692	004	0	1	01	01	H1692_004_0	4	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1692	004	0	1	01	01	H1692_004_0	4	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1692	004	0	1	01	01	H1692_004_0	4	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1692	004	0	1	01	01	H1692_004_0	4	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H1692	004	0	1	01	01	H1692_004_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1692	004	0	1	01	01	H1692_004_0	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1692	004	0	1	01	01	H1692_004_0	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	27						1.00	27												27						27						27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1716	001	0	1	04	01	H1716_001_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					8.00		24.00											10.00		30.00				8.00		0.00				10.00				10.00			0.33	0.27		0.33	0.27	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1716	001	0	1	04	01	H1716_001_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					8.00		24.00											10.00		30.00				8.00		0.00				10.00				10.00			0.33	0.27		0.33	0.27	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1716	001	0	1	04	01	H1716_001_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1716	001	0	1	04	01	H1716_001_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1716	001	0	1	04	01	H1716_001_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1716	001	0	1	04	01	H1716_001_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1716	001	0	1	04	01	H1716_001_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1716	001	0	1	04	01	H1716_001_0	4	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1716	001	0	1	04	01	H1716_001_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1716	001	0	1	04	01	H1716_001_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1716	021	0	1	04	01	H1716_021_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					8.00		24.00											10.00		30.00				8.00		0.00				10.00				10.00			0.33	0.27		0.33	0.27	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1716	021	0	1	04	01	H1716_021_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					8.00		24.00											10.00		30.00				8.00		0.00				10.00				10.00			0.33	0.27		0.33	0.27	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1716	021	0	1	04	01	H1716_021_0	3	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1716	021	0	1	04	01	H1716_021_0	3	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1716	021	0	1	04	01	H1716_021_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1716	021	0	1	04	01	H1716_021_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1716	021	0	1	04	01	H1716_021_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1716	021	0	1	04	01	H1716_021_0	3	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1716	021	0	1	04	01	H1716_021_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1716	021	0	1	04	01	H1716_021_0	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1723	001	0	1	48	05	H1723_001_0	4	Generic Drugs	4	010000			1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H1723	001	0	1	48	05	H1723_001_0	4	Brand Drugs	4	000010			2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H1723	001	0	1	48	05	H1723_001_0	4	Non-Medicare Rx/OTC Drugs	4	010010			3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H1737	001	0	1	01	01	H1737_001_0	7	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	22.50					0.00	0.00	0.00					9.00	18.00	22.50																9.00				9.00			0.30	0.00	0.30			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1737	001	0	1	01	01	H1737_001_0	7	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	50.00					20.00	40.00	40.00					20.00	40.00	50.00																20.00				20.00			0.67	0.67	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1737	001	0	1	01	01	H1737_001_0	7	Preferred Brand	4	000001	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	117.50					47.00	94.00	94.00					47.00	94.00	117.50																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1737	001	0	1	01	01	H1737_001_0	7	Non-Preferred Drug	4	100100	1	1	4	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1737	001	0	1	01	01	H1737_001_0	7	Specialty Tier	4	010010	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1737	003	0	1	01	01	H1737_003_0	7	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	22.50					0.00	0.00	0.00					9.00	18.00	22.50																9.00				9.00			0.30	0.00	0.30			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1737	003	0	1	01	01	H1737_003_0	7	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	50.00					20.00	40.00	40.00					20.00	40.00	50.00																20.00				20.00			0.67	0.67	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1737	003	0	1	01	01	H1737_003_0	7	Preferred Brand	4	000001	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	117.50					47.00	94.00	94.00					47.00	94.00	117.50																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1737	003	0	1	01	01	H1737_003_0	7	Non-Preferred Drug	4	100100	1	1	4	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1737	003	0	1	01	01	H1737_003_0	7	Specialty Tier	4	010010	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1846	004	0	1	04	01	H1846_004_0	10	Preferred Generic	4	001001	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	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	004	0	1	04	01	H1846_004_0	10	Preferred Generic	4	001001	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	004	0	1	04	01	H1846_004_0	10	Generic	4	010001	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	18.00	36.00	54.00																			18.00	36.00	36.00																18.00				18.00		0.60			0.60			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1846	004	0	1	04	01	H1846_004_0	10	Preferred Brand	4	000101	1	2	3	1	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	10	Non-Preferred Drug	4	100100	1	2	4	1	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	10	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31				670.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1849	017	0	1	01	01	H1849_017_0	5	Preferred Generic	4	001000	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												
H1849	017	0	1	01	01	H1849_017_0	5	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								12.00	24.00	36.00					12.00	24.00	36.00					12.00	36.00	36.00																12.00				12.00			0.40	0.40	0.40			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1849	017	0	1	01	01	H1849_017_0	5	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								46.00	92.00	138.00					46.00	92.00	138.00					46.00	138.00	138.00																46.00				46.00			1.53	1.53	1.53			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1849	017	0	1	01	01	H1849_017_0	5	Non-Preferred Drug	4	100100	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												
H1849	017	0	1	01	01	H1849_017_0	5	Specialty Tier	4	010010	1	1	5	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												
H1849	017	0	1	01	01	H1849_017_0	5	Select Care Drugs	4	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1849	017	0	1	01	01	H1849_017_0	5	Select Care Drugs	4	001000	1	2	6	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		
H1849	018	0	1	01	01	H1849_018_0	7	Preferred Generic	4	001000	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												
H1849	018	0	1	01	01	H1849_018_0	7	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								14.00	28.00	42.00					9.00	18.00	27.00					9.00	27.00	27.00																14.00				14.00			0.47	0.30	0.30			0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1849	018	0	1	01	01	H1849_018_0	7	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	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												
H1849	018	0	1	01	01	H1849_018_0	7	Non-Preferred Drug	4	100100	1	2	4	1		111	01	111		1				30	60	90	1	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												
H1849	018	0	1	01	01	H1849_018_0	7	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1849	018	0	1	01	01	H1849_018_0	7	Select Care Drugs	4	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1849	018	0	1	01	01	H1849_018_0	7	Select Care Drugs	4	001000	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1894	001	0	1	01	01	H1894_001_0	8	Preferred Generic	4	001000	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												
H1894	001	0	1	01	01	H1894_001_0	8	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								20.00	40.00	60.00					15.00	30.00	45.00					15.00	45.00	45.00																20.00				20.00			0.67	0.50	0.50			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1894	001	0	1	01	01	H1894_001_0	8	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	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	8	Non-Preferred Drug	4	100100	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												
H1894	001	0	1	01	01	H1894_001_0	8	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1894	001	0	1	01	01	H1894_001_0	8	Select Care Drugs	4	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1894	001	0	1	01	01	H1894_001_0	8	Select Care Drugs	4	001000	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1894	002	0	1	01	01	H1894_002_0	6	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1894	002	0	1	01	01	H1894_002_0	6	Generic	4	010000	1	2	2	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	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								46.00	92.00	138.00					46.00	92.00	138.00					46.00	138.00	138.00																46.00				46.00			1.53	1.53	1.53			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1894	002	0	1	01	01	H1894_002_0	6	Non-Preferred Drug	4	100100	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												
H1894	002	0	1	01	01	H1894_002_0	6	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1894	002	0	1	01	01	H1894_002_0	6	Select Care Drugs	4	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1894	002	0	1	01	01	H1894_002_0	6	Select Care Drugs	4	001000	1	2	6	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		
H1916	001	0	1	48	05	H1916_001_0	6	Generic Drugs	4	010000			1	1	110		01	010		1	30		90				1	1	30						30		34																																														0.00			0.00			0.00	Generic Drugs, Brand Drugs	3	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H1916	001	0	1	48	05	H1916_001_0	6	Brand Drugs	4	000010			2	1	110		01	010		1	30		90				1	1	30						30		34																																														0.00			0.00			0.00	Generic Drugs, Brand Drugs	3	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H1944	001	0	1	01	01	H1944_001_0	7	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	001	0	1	01	01	H1944_001_0	7	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	11.00		33.00																											33.00						0.00				11.00				11.00		0.36						0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	001	0	1	01	01	H1944_001_0	7	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	001	0	1	01	01	H1944_001_0	7	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	001	0	1	01	01	H1944_001_0	7	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				641.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	004	0	1	01	01	H1944_004_0	5	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	004	0	1	01	01	H1944_004_0	5	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	11.00		33.00																											33.00						0.00				11.00				11.00		0.36						0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	004	0	1	01	01	H1944_004_0	5	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	004	0	1	01	01	H1944_004_0	5	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	004	0	1	01	01	H1944_004_0	5	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				561.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	005	0	1	01	01	H1944_005_0	5	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	005	0	1	01	01	H1944_005_0	5	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	9.00		27.00																											27.00						0.00				9.00				9.00		0.30						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	005	0	1	01	01	H1944_005_0	5	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	005	0	1	01	01	H1944_005_0	5	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	005	0	1	01	01	H1944_005_0	5	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				621.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	006	0	1	01	01	H1944_006_0	5	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	006	0	1	01	01	H1944_006_0	5	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	006	0	1	01	01	H1944_006_0	5	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	006	0	1	01	01	H1944_006_0	5	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	006	0	1	01	01	H1944_006_0	5	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				653.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	007	0	1	01	01	H1944_007_0	5	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		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	007	0	1	01	01	H1944_007_0	5	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	9.00		27.00																											27.00						0.00				9.00				9.00		0.30						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	007	0	1	01	01	H1944_007_0	5	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	007	0	1	01	01	H1944_007_0	5	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	007	0	1	01	01	H1944_007_0	5	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				648.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	008	0	1	01	01	H1944_008_0	5	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	008	0	1	01	01	H1944_008_0	5	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	008	0	1	01	01	H1944_008_0	5	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	008	0	1	01	01	H1944_008_0	5	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	008	0	1	01	01	H1944_008_0	5	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				651.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	009	0	1	01	01	H1944_009_0	5	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	009	0	1	01	01	H1944_009_0	5	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	009	0	1	01	01	H1944_009_0	5	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	009	0	1	01	01	H1944_009_0	5	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	009	0	1	01	01	H1944_009_0	5	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				748.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	010	0	1	01	01	H1944_010_0	5	Preferred Generic	3	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	010	0	1	01	01	H1944_010_0	5	Generic	3	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	010	0	1	01	01	H1944_010_0	5	Preferred Brand	3	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	010	0	1	01	01	H1944_010_0	5	Non-Preferred Drug	3	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	010	0	1	01	01	H1944_010_0	5	Specialty Tier	3	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				867.00	27		27																										27						27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	011	0	1	01	01	H1944_011_0	5	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	011	0	1	01	01	H1944_011_0	5	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	011	0	1	01	01	H1944_011_0	5	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	011	0	1	01	01	H1944_011_0	5	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	011	0	1	01	01	H1944_011_0	5	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				1014.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	012	0	1	01	01	H1944_012_0	5	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	012	0	1	01	01	H1944_012_0	5	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		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	012	0	1	01	01	H1944_012_0	5	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		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	012	0	1	01	01	H1944_012_0	5	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		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	012	0	1	01	01	H1944_012_0	5	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				864.00	27		27																										27						27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	013	0	1	01	01	H1944_013_0	5	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	013	0	1	01	01	H1944_013_0	5	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	013	0	1	01	01	H1944_013_0	5	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	013	0	1	01	01	H1944_013_0	5	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	013	0	1	01	01	H1944_013_0	5	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				1023.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	014	0	1	01	01	H1944_014_0	5	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	014	0	1	01	01	H1944_014_0	5	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	9.00		27.00																											27.00						0.00				9.00				9.00		0.30						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	014	0	1	01	01	H1944_014_0	5	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	014	0	1	01	01	H1944_014_0	5	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	014	0	1	01	01	H1944_014_0	5	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				696.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	016	0	1	01	01	H1944_016_0	5	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	016	0	1	01	01	H1944_016_0	5	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	9.00		27.00																											27.00						0.00				9.00				9.00		0.30						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	016	0	1	01	01	H1944_016_0	5	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	016	0	1	01	01	H1944_016_0	5	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	016	0	1	01	01	H1944_016_0	5	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				640.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	017	0	1	01	01	H1944_017_0	5	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	017	0	1	01	01	H1944_017_0	5	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	017	0	1	01	01	H1944_017_0	5	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	017	0	1	01	01	H1944_017_0	5	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	017	0	1	01	01	H1944_017_0	5	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				754.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	018	0	1	01	01	H1944_018_0	5	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	018	0	1	01	01	H1944_018_0	5	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	018	0	1	01	01	H1944_018_0	5	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	018	0	1	01	01	H1944_018_0	5	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	018	0	1	01	01	H1944_018_0	5	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				530.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	019	0	1	01	01	H1944_019_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	019	0	1	01	01	H1944_019_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	019	0	1	01	01	H1944_019_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	019	0	1	01	01	H1944_019_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	019	0	1	01	01	H1944_019_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				802.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	020	0	1	01	01	H1944_020_0	5	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	020	0	1	01	01	H1944_020_0	5	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	020	0	1	01	01	H1944_020_0	5	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	020	0	1	01	01	H1944_020_0	5	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	020	0	1	01	01	H1944_020_0	5	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				789.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	021	0	1	01	01	H1944_021_0	5	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	021	0	1	01	01	H1944_021_0	5	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	021	0	1	01	01	H1944_021_0	5	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	021	0	1	01	01	H1944_021_0	5	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	021	0	1	01	01	H1944_021_0	5	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				727.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	022	0	1	01	01	H1944_022_0	5	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	022	0	1	01	01	H1944_022_0	5	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	022	0	1	01	01	H1944_022_0	5	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	022	0	1	01	01	H1944_022_0	5	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	022	0	1	01	01	H1944_022_0	5	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				727.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	023	0	1	01	01	H1944_023_0	5	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	023	0	1	01	01	H1944_023_0	5	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	023	0	1	01	01	H1944_023_0	5	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	023	0	1	01	01	H1944_023_0	5	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	023	0	1	01	01	H1944_023_0	5	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				727.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	024	0	1	01	01	H1944_024_0	5	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	024	0	1	01	01	H1944_024_0	5	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	024	0	1	01	01	H1944_024_0	5	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	024	0	1	01	01	H1944_024_0	5	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	024	0	1	01	01	H1944_024_0	5	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				808.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	025	0	1	01	01	H1944_025_0	5	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	025	0	1	01	01	H1944_025_0	5	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	025	0	1	01	01	H1944_025_0	5	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	025	0	1	01	01	H1944_025_0	5	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	025	0	1	01	01	H1944_025_0	5	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				917.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	026	0	1	01	01	H1944_026_0	5	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	026	0	1	01	01	H1944_026_0	5	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	026	0	1	01	01	H1944_026_0	5	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	026	0	1	01	01	H1944_026_0	5	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1944	026	0	1	01	01	H1944_026_0	5	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				917.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	013	0	1	01	01	H1951_013_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	013	0	1	01	01	H1951_013_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1951	013	0	1	01	01	H1951_013_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	013	0	1	01	01	H1951_013_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1951	013	0	1	01	01	H1951_013_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	013	0	1	01	01	H1951_013_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1951	013	0	1	01	01	H1951_013_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	013	0	1	01	01	H1951_013_0	4	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1951	013	0	1	01	01	H1951_013_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	013	0	1	01	01	H1951_013_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1951	024	0	1	01	01	H1951_024_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	024	0	1	01	01	H1951_024_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1951	024	0	1	01	01	H1951_024_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								17.00		51.00					12.00		36.00											17.00		51.00				12.00		0.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	024	0	1	01	01	H1951_024_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								17.00		51.00					12.00		36.00											17.00		51.00				12.00		0.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1951	024	0	1	01	01	H1951_024_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	024	0	1	01	01	H1951_024_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1951	024	0	1	01	01	H1951_024_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	024	0	1	01	01	H1951_024_0	4	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1951	024	0	1	01	01	H1951_024_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	024	0	1	01	01	H1951_024_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1951	025	0	1	01	01	H1951_025_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	025	0	1	01	01	H1951_025_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1951	025	0	1	01	01	H1951_025_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	025	0	1	01	01	H1951_025_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1951	025	0	1	01	01	H1951_025_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	025	0	1	01	01	H1951_025_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1951	025	0	1	01	01	H1951_025_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	025	0	1	01	01	H1951_025_0	4	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1951	025	0	1	01	01	H1951_025_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	025	0	1	01	01	H1951_025_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1951	028	0	1	01	01	H1951_028_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	028	0	1	01	01	H1951_028_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1951	028	0	1	01	01	H1951_028_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								19.00		57.00					14.00		42.00											19.00		57.00				14.00		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												
H1951	028	0	1	01	01	H1951_028_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								19.00		57.00					14.00		42.00											19.00		57.00				14.00		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										2	3	
H1951	028	0	1	01	01	H1951_028_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	028	0	1	01	01	H1951_028_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1951	028	0	1	01	01	H1951_028_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	028	0	1	01	01	H1951_028_0	4	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1951	028	0	1	01	01	H1951_028_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	028	0	1	01	01	H1951_028_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1951	032	0	1	01	01	H1951_032_0	4	Preferred Generic	3	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	032	0	1	01	01	H1951_032_0	4	Generic	3	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	032	0	1	01	01	H1951_032_0	4	Preferred Brand	3	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	032	0	1	01	01	H1951_032_0	4	Non-Preferred Drug	3	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	032	0	1	01	01	H1951_032_0	4	Specialty Tier	3	010010	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	033	0	1	01	01	H1951_033_0	4	Preferred Generic	3	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	033	0	1	01	01	H1951_033_0	4	Generic	3	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								17.00		51.00					12.00		36.00											17.00		51.00				12.00		0.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	033	0	1	01	01	H1951_033_0	4	Preferred Brand	3	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	033	0	1	01	01	H1951_033_0	4	Non-Preferred Drug	3	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	033	0	1	01	01	H1951_033_0	4	Specialty Tier	3	010010	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	034	0	1	01	01	H1951_034_0	4	Preferred Generic	3	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	034	0	1	01	01	H1951_034_0	4	Generic	3	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	034	0	1	01	01	H1951_034_0	4	Preferred Brand	3	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	034	0	1	01	01	H1951_034_0	4	Non-Preferred Drug	3	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	034	0	1	01	01	H1951_034_0	4	Specialty Tier	3	010010	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	038	0	1	01	01	H1951_038_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	038	0	1	01	01	H1951_038_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1951	038	0	1	01	01	H1951_038_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	038	0	1	01	01	H1951_038_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1951	038	0	1	01	01	H1951_038_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	038	0	1	01	01	H1951_038_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1951	038	0	1	01	01	H1951_038_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	038	0	1	01	01	H1951_038_0	4	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1951	038	0	1	01	01	H1951_038_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	038	0	1	01	01	H1951_038_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1951	039	0	1	01	01	H1951_039_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	039	0	1	01	01	H1951_039_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1951	039	0	1	01	01	H1951_039_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	039	0	1	01	01	H1951_039_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1951	039	0	1	01	01	H1951_039_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	039	0	1	01	01	H1951_039_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1951	039	0	1	01	01	H1951_039_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	039	0	1	01	01	H1951_039_0	4	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1951	039	0	1	01	01	H1951_039_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	039	0	1	01	01	H1951_039_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1951	041	0	1	01	01	H1951_041_0	4	Preferred Generic	3	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	041	0	1	01	01	H1951_041_0	4	Generic	3	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								19.00		57.00					14.00		42.00											19.00		57.00				14.00		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												
H1951	041	0	1	01	01	H1951_041_0	4	Preferred Brand	3	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	041	0	1	01	01	H1951_041_0	4	Non-Preferred Drug	3	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	041	0	1	01	01	H1951_041_0	4	Specialty Tier	3	010010	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	042	0	1	01	01	H1951_042_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	042	0	1	01	01	H1951_042_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1951	042	0	1	01	01	H1951_042_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								15.00		45.00					10.00		30.00											15.00		45.00				10.00		0.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	042	0	1	01	01	H1951_042_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								15.00		45.00					10.00		30.00											15.00		45.00				10.00		0.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1951	042	0	1	01	01	H1951_042_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	042	0	1	01	01	H1951_042_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1951	042	0	1	01	01	H1951_042_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	042	0	1	01	01	H1951_042_0	4	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1951	042	0	1	01	01	H1951_042_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	042	0	1	01	01	H1951_042_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1951	044	0	1	01	01	H1951_044_0	5	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	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	5	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H1951	044	0	1	01	01	H1951_044_0	5	Generic	4	010001	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								15.00		45.00					10.00		30.00											15.00		45.00				10.00		0.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1951	044	0	1	01	01	H1951_044_0	5	Generic	4	010001	3	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								13.00		39.00					8.00		24.00											13.00		39.00				8.00		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, Select Care Drugs										2	3	3
H1951	044	0	1	01	01	H1951_044_0	5	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1951	044	0	1	01	01	H1951_044_0	5	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H1951	044	0	1	01	01	H1951_044_0	5	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1951	044	0	1	01	01	H1951_044_0	5	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H1951	044	0	1	01	01	H1951_044_0	5	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1951	044	0	1	01	01	H1951_044_0	5	Specialty Tier	4	010010	1	1	5	3		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										2	3	
H1951	044	0	1	01	01	H1951_044_0	5	Select Care Drugs	4	010010	1	2	6	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1951	044	0	1	01	01	H1951_044_0	5	Select Care Drugs	4	010010	1	2	6	3		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H1951	047	1	1	01	01	H1951_047_1	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	047	1	1	01	01	H1951_047_1	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1951	047	1	1	01	01	H1951_047_1	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	047	1	1	01	01	H1951_047_1	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1951	047	1	1	01	01	H1951_047_1	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	047	1	1	01	01	H1951_047_1	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1951	047	1	1	01	01	H1951_047_1	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	047	1	1	01	01	H1951_047_1	4	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1951	047	1	1	01	01	H1951_047_1	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	047	1	1	01	01	H1951_047_1	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1951	047	2	1	01	01	H1951_047_2	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	047	2	1	01	01	H1951_047_2	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1951	047	2	1	01	01	H1951_047_2	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	047	2	1	01	01	H1951_047_2	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1951	047	2	1	01	01	H1951_047_2	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	047	2	1	01	01	H1951_047_2	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1951	047	2	1	01	01	H1951_047_2	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	047	2	1	01	01	H1951_047_2	4	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1951	047	2	1	01	01	H1951_047_2	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	047	2	1	01	01	H1951_047_2	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1951	048	1	1	01	01	H1951_048_1	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	048	1	1	01	01	H1951_048_1	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1951	048	1	1	01	01	H1951_048_1	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	048	1	1	01	01	H1951_048_1	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1951	048	1	1	01	01	H1951_048_1	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	048	1	1	01	01	H1951_048_1	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1951	048	1	1	01	01	H1951_048_1	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	048	1	1	01	01	H1951_048_1	4	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1951	048	1	1	01	01	H1951_048_1	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	048	1	1	01	01	H1951_048_1	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1951	048	2	1	01	01	H1951_048_2	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	048	2	1	01	01	H1951_048_2	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1951	048	2	1	01	01	H1951_048_2	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	048	2	1	01	01	H1951_048_2	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1951	048	2	1	01	01	H1951_048_2	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	048	2	1	01	01	H1951_048_2	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1951	048	2	1	01	01	H1951_048_2	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	048	2	1	01	01	H1951_048_2	4	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1951	048	2	1	01	01	H1951_048_2	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H1951	048	2	1	01	01	H1951_048_2	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H1961	007	0	1	01	01	H1961_007_0	15	Preferred Generic	4	001000	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								3.00		9.00					0.00		0.00													9.00						0.00				3.00				3.00			0.10	0.00				0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1961	007	0	1	01	01	H1961_007_0	15	Preferred Generic	4	001000	1	2	1	3		110	01		100	1				30		90	2	2						90	30		31								3.00		9.00					0.00		0.00													9.00						0.00				3.00				3.00			0.10	0.00				0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1961	007	0	1	01	01	H1961_007_0	15	Generic	4	010000	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			0.57	0.40				0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1961	007	0	1	01	01	H1961_007_0	15	Generic	4	010000	1	2	2	3		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			0.57	0.40				0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1961	007	0	1	01	01	H1961_007_0	15	Preferred Brand	4	010001	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					37.00		111.00													141.00						111.00				47.00				47.00			1.57	1.23				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1961	007	0	1	01	01	H1961_007_0	15	Non-Preferred Brand	4	110000	1	2	4	1		110	01		100	1				30		90	2	2						90	30		31								100.00		300.00					90.00		270.00													300.00						270.00				100.00				100.00			3.33	3.00				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1961	007	0	1	01	01	H1961_007_0	15	Specialty Tier	4	010010	1	1	5	1		110	01		100	1				30		90	2	2						90	30		31											515.27	33		33				515.27	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1961	009	0	1	01	01	H1961_009_0	9	Preferred Generic	4	001000	1	2	1	1		110	01		100	1				30		90	2	2						90	30		31								3.00		9.00					0.00		0.00													9.00						0.00				3.00				3.00			0.10	0.00				0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1961	009	0	1	01	01	H1961_009_0	9	Preferred Generic	4	001000	1	2	1	3		110	01		100	1				30		90	2	2						90	30		31								3.00		9.00					0.00		0.00													9.00						0.00				3.00				3.00			0.10	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1961	009	0	1	01	01	H1961_009_0	9	Generic	4	010000	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 Brand, Specialty Tier												
H1961	009	0	1	01	01	H1961_009_0	9	Generic	4	010000	1	2	2	3		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				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1961	009	0	1	01	01	H1961_009_0	9	Preferred Brand	4	010001	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					37.00		111.00													141.00						111.00				47.00				47.00			1.57	1.23				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1961	009	0	1	01	01	H1961_009_0	9	Non-Preferred Brand	4	110000	1	2	4	1		110	01		100	1				30		90	2	2						90	30		31								90.00		270.00					80.00		240.00													270.00						240.00				90.00				90.00			3.00	2.67				2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1961	009	0	1	01	01	H1961_009_0	9	Specialty Tier	4	010010	1	1	5	1		110	01		100	1				30		90	2	2						90	30		31											498.94	33		33				498.94	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1961	014	1	1	01	01	H1961_014_1	11	Preferred Generic	4	001000	1	2	1	1		110	01		100	1				30		90	2	2						90	30		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 Brand, Specialty Tier												
H1961	014	1	1	01	01	H1961_014_1	11	Preferred Generic	4	001000	1	2	1	3		110	01		100	1				30		90	2	2						90	30		31								4.00		12.00					0.00		0.00													12.00						0.00				4.00				4.00			0.13	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1961	014	1	1	01	01	H1961_014_1	11	Generic	4	010000	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 Brand, Specialty Tier												
H1961	014	1	1	01	01	H1961_014_1	11	Generic	4	010000	1	2	2	3		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				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1961	014	1	1	01	01	H1961_014_1	11	Preferred Brand	4	010001	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					37.00		111.00													141.00						111.00				47.00				47.00			1.57	1.23				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1961	014	1	1	01	01	H1961_014_1	11	Non-Preferred Brand	4	110000	1	2	4	1		110	01		100	1				30		90	2	2						90	30		31								90.00		270.00					80.00		240.00													270.00						240.00				90.00				90.00			3.00	2.67				2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1961	014	1	1	01	01	H1961_014_1	11	Specialty Tier	4	010010	1	1	5	1		110	01		100	1				30		90	2	2						90	30		31											498.94	33		33				498.94	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1961	014	2	1	01	01	H1961_014_2	11	Preferred Generic	4	001000	1	2	1	1		110	01		100	1				30		90	2	2						90	30		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 Brand, Specialty Tier												
H1961	014	2	1	01	01	H1961_014_2	11	Preferred Generic	4	001000	1	2	1	3		110	01		100	1				30		90	2	2						90	30		31								4.00		12.00					0.00		0.00													12.00						0.00				4.00				4.00			0.13	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1961	014	2	1	01	01	H1961_014_2	11	Generic	4	010000	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 Brand, Specialty Tier												
H1961	014	2	1	01	01	H1961_014_2	11	Generic	4	010000	1	2	2	3		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				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1961	014	2	1	01	01	H1961_014_2	11	Preferred Brand	4	010001	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					37.00		111.00													141.00						111.00				47.00				47.00			1.57	1.23				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1961	014	2	1	01	01	H1961_014_2	11	Non-Preferred Brand	4	110000	1	2	4	1		110	01		100	1				30		90	2	2						90	30		31								90.00		270.00					80.00		240.00													270.00						240.00				90.00				90.00			3.00	2.67				2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1961	014	2	1	01	01	H1961_014_2	11	Specialty Tier	4	010010	1	1	5	1		110	01		100	1				30		90	2	2						90	30		31											498.94	33		33				498.94	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1961	016	0	1	01	01	H1961_016_0	13	Preferred Generic	4	001000	1	2	1	1		110	01		100	1				30		90	2	2						90	30		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 Brand, Specialty Tier												
H1961	016	0	1	01	01	H1961_016_0	13	Preferred Generic	4	001000	1	2	1	3		110	01		100	1				30		90	2	2						90	30		31								4.00		12.00					0.00		0.00													12.00						0.00				4.00				4.00			0.13	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1961	016	0	1	01	01	H1961_016_0	13	Generic	4	010000	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 Brand, Specialty Tier												
H1961	016	0	1	01	01	H1961_016_0	13	Generic	4	010000	1	2	2	3		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				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1961	016	0	1	01	01	H1961_016_0	13	Preferred Brand	4	010001	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					37.00		111.00													141.00						111.00				47.00				47.00			1.57	1.23				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1961	016	0	1	01	01	H1961_016_0	13	Non-Preferred Brand	4	110000	1	2	4	1		110	01		100	1				30		90	2	2						90	30		31								90.00		270.00					80.00		240.00													270.00						240.00				90.00				90.00			3.00	2.67				2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1961	016	0	1	01	01	H1961_016_0	13	Specialty Tier	4	010010	1	1	5	1		110	01		100	1				30		90	2	2						90	30		31											498.94	33		33				498.94	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1961	017	0	1	01	01	H1961_017_0	17	Preferred Generic	4	001000	1	2	1	1		110	01		100	1				30		90	2	2						90	30		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 Brand, Specialty Tier												
H1961	017	0	1	01	01	H1961_017_0	17	Preferred Generic	4	001000	1	2	1	3		110	01		100	1				30		90	2	2						90	30		31								4.00		12.00					0.00		0.00													12.00						0.00				4.00				4.00			0.13	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1961	017	0	1	01	01	H1961_017_0	17	Generic	4	010000	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 Brand, Specialty Tier												
H1961	017	0	1	01	01	H1961_017_0	17	Generic	4	010000	1	2	2	3		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				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H1961	017	0	1	01	01	H1961_017_0	17	Preferred Brand	4	010001	1	2	3	1		110	01		100	1				30		90	2	2						90	30		31								47.00		141.00					37.00		111.00													141.00						111.00				47.00				47.00			1.57	1.23				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1961	017	0	1	01	01	H1961_017_0	17	Non-Preferred Brand	4	110000	1	2	4	1		110	01		100	1				30		90	2	2						90	30		31								90.00		270.00					80.00		240.00													270.00						240.00				90.00				90.00			3.00	2.67				2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1961	017	0	1	01	01	H1961_017_0	17	Specialty Tier	4	010010	1	1	5	1		110	01		100	1				30		90	2	2						90	30		31											498.94	33		33				498.94	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1969	002	0	1	01	01	H1969_002_0	6	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	6.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1969	002	0	1	01	01	H1969_002_0	6	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	9.00	18.00	18.00																			9.00	18.00	18.00																9.00				9.00		0.30			0.30			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1969	002	0	1	01	01	H1969_002_0	6	Preferred Brand	4	000001	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, Select Care Drugs												
H1969	002	0	1	01	01	H1969_002_0	6	Non-Preferred Drug	4	100100	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				76.00	40	40	40																		40	40	40															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1969	002	0	1	01	01	H1969_002_0	6	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31				1230.90	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1969	002	0	1	01	01	H1969_002_0	6	Select Care Drugs	4	010000	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1969	003	0	1	01	01	H1969_003_0	6	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	6.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1969	003	0	1	01	01	H1969_003_0	6	Generic	4	010000	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, Select Care Drugs												
H1969	003	0	1	01	01	H1969_003_0	6	Preferred Brand	4	000001	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, Select Care Drugs												
H1969	003	0	1	01	01	H1969_003_0	6	Non-Preferred Drug	4	100100	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				76.00	40	40	40																		40	40	40															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1969	003	0	1	01	01	H1969_003_0	6	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31				1230.90	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1969	003	0	1	01	01	H1969_003_0	6	Select Care Drugs	4	010000	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1977	001	0	1	48	05	H1977_001_0	3	Generic Drugs	4	010000			1	1	010		01			1	30														30		31																																														0.00						0.00	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	3	Brand Drugs	4	000010			2	1	010		01			1	30														30		31																																														0.00						0.00	Generic Drugs, Brand Drugs	3	0.00	0.00	0.00	0.00			0.00	0.00			
H1994	001	0	1	01	01	H1994_001_0	7	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	001	0	1	01	01	H1994_001_0	7	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	001	0	1	01	01	H1994_001_0	7	Preferred Brand	4	000001	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	001	0	1	01	01	H1994_001_0	7	Non-Preferred Brand	4	100000	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	001	0	1	01	01	H1994_001_0	7	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31				2222.48	29																				29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	002	0	1	01	01	H1994_002_0	7	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	002	0	1	01	01	H1994_002_0	7	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	002	0	1	01	01	H1994_002_0	7	Preferred Brand	4	000001	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	002	0	1	01	01	H1994_002_0	7	Non-Preferred Brand	4	100000	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	002	0	1	01	01	H1994_002_0	7	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31				2369.85	29																				29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	003	0	1	01	01	H1994_003_0	6	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	003	0	1	01	01	H1994_003_0	6	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	003	0	1	01	01	H1994_003_0	6	Preferred Brand	4	000001	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	003	0	1	01	01	H1994_003_0	6	Non-Preferred Brand	4	100000	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	003	0	1	01	01	H1994_003_0	6	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31				1972.31	30																				30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	004	0	1	01	01	H1994_004_0	6	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	004	0	1	01	01	H1994_004_0	6	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	004	0	1	01	01	H1994_004_0	6	Preferred Brand	4	000001	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	004	0	1	01	01	H1994_004_0	6	Non-Preferred Brand	4	100000	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	004	0	1	01	01	H1994_004_0	6	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31				3430.88	30																				30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	005	0	1	01	01	H1994_005_0	8	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	005	0	1	01	01	H1994_005_0	8	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	005	0	1	01	01	H1994_005_0	8	Preferred Brand	4	000001	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	005	0	1	01	01	H1994_005_0	8	Non-Preferred Brand	4	100000	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	005	0	1	01	01	H1994_005_0	8	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31				1454.78	29																				29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	006	0	1	01	01	H1994_006_0	6	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	006	0	1	01	01	H1994_006_0	6	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	006	0	1	01	01	H1994_006_0	6	Preferred Brand	4	000001	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	006	0	1	01	01	H1994_006_0	6	Non-Preferred Brand	4	100000	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	006	0	1	01	01	H1994_006_0	6	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31				8477.86	29																				29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	007	0	1	01	01	H1994_007_0	9	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	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	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	007	0	1	01	01	H1994_007_0	9	Preferred Brand	4	000001	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	007	0	1	01	01	H1994_007_0	9	Non-Preferred Brand	4	100000	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	007	0	1	01	01	H1994_007_0	9	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31				2529.03	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	008	0	1	01	01	H1994_008_0	7	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	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	7	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	008	0	1	01	01	H1994_008_0	7	Preferred Brand	4	000001	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	008	0	1	01	01	H1994_008_0	7	Non-Preferred Brand	4	100000	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1994	008	0	1	01	01	H1994_008_0	7	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31				2169.54	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H1997	002	0	1	01	01	H1997_002_0	6	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	6.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1997	002	0	1	01	01	H1997_002_0	6	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	20.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1997	002	0	1	01	01	H1997_002_0	6	Preferred Brand	4	000001	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, Select Care Drugs												
H1997	002	0	1	01	01	H1997_002_0	6	Non-Preferred Drug	4	100100	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				76.00	40	40	40																		40	40	40															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1997	002	0	1	01	01	H1997_002_0	6	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31				1230.90	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H1997	002	0	1	01	01	H1997_002_0	6	Select Care Drugs	4	010000	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2001	001	0	1	04	01	H2001_001_0	5	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2001	001	0	1	04	01	H2001_001_0	5	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	9.00		27.00																											27.00						0.00				9.00				9.00		0.30						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2001	001	0	1	04	01	H2001_001_0	5	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		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	001	0	1	04	01	H2001_001_0	5	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2001	001	0	1	04	01	H2001_001_0	5	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				634.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2001	010	0	1	04	01	H2001_010_0	5	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2001	010	0	1	04	01	H2001_010_0	5	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2001	010	0	1	04	01	H2001_010_0	5	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		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	010	0	1	04	01	H2001_010_0	5	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2001	010	0	1	04	01	H2001_010_0	5	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				703.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2001	017	0	1	04	01	H2001_017_0	5	Preferred Generic	3	001000	1	2	1	1	110		01		100	1	30		100				1	2						100	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2001	017	0	1	04	01	H2001_017_0	5	Generic	3	010000	1	2	2	1	110		01		100	1	30		100				1	2						100	30		31	13.00		39.00																											39.00						0.00				13.00				13.00		0.43						0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2001	017	0	1	04	01	H2001_017_0	5	Preferred Brand	3	010001	1	2	3	1	110		01		100	1	30		100				1	2						100	30		31	47.00		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	017	0	1	04	01	H2001_017_0	5	Non-Preferred Drug	3	100100	1	2	4	1	110		01		100	1	30		100				1	2						100	30		31	100.00		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	5	Specialty Tier	3	010010	1	1	5	1	110		01		100	1	30		100				1	2						100	30		31				611.00	25		25																										25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	002	0	1	01	01	H2012_002_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	002	0	1	01	01	H2012_002_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	002	0	1	01	01	H2012_002_0	3	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	002	0	1	01	01	H2012_002_0	3	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	002	0	1	01	01	H2012_002_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	002	0	1	01	01	H2012_002_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	002	0	1	01	01	H2012_002_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	002	0	1	01	01	H2012_002_0	3	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	002	0	1	01	01	H2012_002_0	3	Specialty Tier	4	010010	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												
H2012	002	0	1	01	01	H2012_002_0	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	003	0	1	01	01	H2012_003_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	003	0	1	01	01	H2012_003_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	003	0	1	01	01	H2012_003_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	003	0	1	01	01	H2012_003_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	003	0	1	01	01	H2012_003_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	003	0	1	01	01	H2012_003_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	003	0	1	01	01	H2012_003_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	003	0	1	01	01	H2012_003_0	4	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	003	0	1	01	01	H2012_003_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	003	0	1	01	01	H2012_003_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	006	0	1	01	01	H2012_006_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	006	0	1	01	01	H2012_006_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	006	0	1	01	01	H2012_006_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	006	0	1	01	01	H2012_006_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	006	0	1	01	01	H2012_006_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	006	0	1	01	01	H2012_006_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	006	0	1	01	01	H2012_006_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	006	0	1	01	01	H2012_006_0	4	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	006	0	1	01	01	H2012_006_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	006	0	1	01	01	H2012_006_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	008	0	1	01	01	H2012_008_0	5	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	008	0	1	01	01	H2012_008_0	5	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	008	0	1	01	01	H2012_008_0	5	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	008	0	1	01	01	H2012_008_0	5	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	008	0	1	01	01	H2012_008_0	5	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	008	0	1	01	01	H2012_008_0	5	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	008	0	1	01	01	H2012_008_0	5	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	008	0	1	01	01	H2012_008_0	5	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	008	0	1	01	01	H2012_008_0	5	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	008	0	1	01	01	H2012_008_0	5	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	009	0	1	01	01	H2012_009_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	009	0	1	01	01	H2012_009_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	009	0	1	01	01	H2012_009_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	009	0	1	01	01	H2012_009_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	009	0	1	01	01	H2012_009_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	009	0	1	01	01	H2012_009_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	009	0	1	01	01	H2012_009_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	009	0	1	01	01	H2012_009_0	4	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	009	0	1	01	01	H2012_009_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	009	0	1	01	01	H2012_009_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	011	0	1	01	01	H2012_011_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	011	0	1	01	01	H2012_011_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	011	0	1	01	01	H2012_011_0	3	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	011	0	1	01	01	H2012_011_0	3	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	011	0	1	01	01	H2012_011_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	011	0	1	01	01	H2012_011_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	011	0	1	01	01	H2012_011_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	011	0	1	01	01	H2012_011_0	3	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	011	0	1	01	01	H2012_011_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	011	0	1	01	01	H2012_011_0	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	012	0	1	01	01	H2012_012_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	012	0	1	01	01	H2012_012_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	012	0	1	01	01	H2012_012_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	012	0	1	01	01	H2012_012_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	012	0	1	01	01	H2012_012_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	012	0	1	01	01	H2012_012_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	012	0	1	01	01	H2012_012_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	012	0	1	01	01	H2012_012_0	4	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	012	0	1	01	01	H2012_012_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	012	0	1	01	01	H2012_012_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	015	0	1	01	01	H2012_015_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	015	0	1	01	01	H2012_015_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	015	0	1	01	01	H2012_015_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	015	0	1	01	01	H2012_015_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	015	0	1	01	01	H2012_015_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	015	0	1	01	01	H2012_015_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	015	0	1	01	01	H2012_015_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	015	0	1	01	01	H2012_015_0	4	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	015	0	1	01	01	H2012_015_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	015	0	1	01	01	H2012_015_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	016	0	1	01	01	H2012_016_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	016	0	1	01	01	H2012_016_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	016	0	1	01	01	H2012_016_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	016	0	1	01	01	H2012_016_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	016	0	1	01	01	H2012_016_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	016	0	1	01	01	H2012_016_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	016	0	1	01	01	H2012_016_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	016	0	1	01	01	H2012_016_0	4	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	016	0	1	01	01	H2012_016_0	4	Specialty Tier	4	010010	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												
H2012	016	0	1	01	01	H2012_016_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	021	0	1	01	01	H2012_021_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	021	0	1	01	01	H2012_021_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	021	0	1	01	01	H2012_021_0	3	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					19.00		57.00											20.00		60.00				19.00		0.00				20.00				20.00			0.67	0.63		0.67	0.63	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	021	0	1	01	01	H2012_021_0	3	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					19.00		57.00											20.00		60.00				19.00		0.00				20.00				20.00			0.67	0.63		0.67	0.63	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	021	0	1	01	01	H2012_021_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	021	0	1	01	01	H2012_021_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	021	0	1	01	01	H2012_021_0	3	Non-Preferred Drug	4	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											91.00	50		50				90.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	021	0	1	01	01	H2012_021_0	3	Non-Preferred Drug	4	110000	1	1	4	3		110	01		110	1				30		90	2	2				30		90	30		31											84.00	31		31				84.00	31		31										31		31				31		31			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	021	0	1	01	01	H2012_021_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	021	0	1	01	01	H2012_021_0	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	022	0	1	01	01	H2012_022_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								8.00		24.00					3.00		9.00											8.00		24.00				3.00		0.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	022	0	1	01	01	H2012_022_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								8.00		24.00					3.00		9.00											8.00		24.00				3.00		0.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	022	0	1	01	01	H2012_022_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	022	0	1	01	01	H2012_022_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	022	0	1	01	01	H2012_022_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	022	0	1	01	01	H2012_022_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	022	0	1	01	01	H2012_022_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	022	0	1	01	01	H2012_022_0	4	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	022	0	1	01	01	H2012_022_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	022	0	1	01	01	H2012_022_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	027	0	1	01	01	H2012_027_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	027	0	1	01	01	H2012_027_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	027	0	1	01	01	H2012_027_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	027	0	1	01	01	H2012_027_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	027	0	1	01	01	H2012_027_0	4	Preferred Brand	4	010001	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												
H2012	027	0	1	01	01	H2012_027_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	027	0	1	01	01	H2012_027_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	027	0	1	01	01	H2012_027_0	4	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	027	0	1	01	01	H2012_027_0	4	Specialty Tier	4	010010	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												
H2012	027	0	1	01	01	H2012_027_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	028	0	1	01	01	H2012_028_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	028	0	1	01	01	H2012_028_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	028	0	1	01	01	H2012_028_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	028	0	1	01	01	H2012_028_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	028	0	1	01	01	H2012_028_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	028	0	1	01	01	H2012_028_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	028	0	1	01	01	H2012_028_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	028	0	1	01	01	H2012_028_0	4	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	028	0	1	01	01	H2012_028_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	028	0	1	01	01	H2012_028_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	029	0	1	01	01	H2012_029_0	5	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	029	0	1	01	01	H2012_029_0	5	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	029	0	1	01	01	H2012_029_0	5	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	029	0	1	01	01	H2012_029_0	5	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	029	0	1	01	01	H2012_029_0	5	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	029	0	1	01	01	H2012_029_0	5	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	029	0	1	01	01	H2012_029_0	5	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	029	0	1	01	01	H2012_029_0	5	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	029	0	1	01	01	H2012_029_0	5	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	029	0	1	01	01	H2012_029_0	5	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	030	0	1	01	01	H2012_030_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								9.00		27.00					4.00		12.00											9.00		27.00				4.00		0.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	030	0	1	01	01	H2012_030_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								9.00		27.00					4.00		12.00											9.00		27.00				4.00		0.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	030	0	1	01	01	H2012_030_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	030	0	1	01	01	H2012_030_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	030	0	1	01	01	H2012_030_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	030	0	1	01	01	H2012_030_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	030	0	1	01	01	H2012_030_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	030	0	1	01	01	H2012_030_0	4	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	030	0	1	01	01	H2012_030_0	4	Specialty Tier	4	010010	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												
H2012	030	0	1	01	01	H2012_030_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	031	0	1	01	01	H2012_031_0	5	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								9.00		27.00					4.00		12.00											9.00		27.00				4.00		0.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	031	0	1	01	01	H2012_031_0	5	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								9.00		27.00					4.00		12.00											9.00		27.00				4.00		0.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	031	0	1	01	01	H2012_031_0	5	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	031	0	1	01	01	H2012_031_0	5	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	031	0	1	01	01	H2012_031_0	5	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	031	0	1	01	01	H2012_031_0	5	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	031	0	1	01	01	H2012_031_0	5	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	031	0	1	01	01	H2012_031_0	5	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	031	0	1	01	01	H2012_031_0	5	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	031	0	1	01	01	H2012_031_0	5	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	033	0	1	01	01	H2012_033_0	5	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								9.00		27.00					4.00		12.00											9.00		27.00				4.00		0.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	033	0	1	01	01	H2012_033_0	5	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								9.00		27.00					4.00		12.00											9.00		27.00				4.00		0.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	033	0	1	01	01	H2012_033_0	5	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	033	0	1	01	01	H2012_033_0	5	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	033	0	1	01	01	H2012_033_0	5	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	033	0	1	01	01	H2012_033_0	5	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	033	0	1	01	01	H2012_033_0	5	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	033	0	1	01	01	H2012_033_0	5	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	033	0	1	01	01	H2012_033_0	5	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	033	0	1	01	01	H2012_033_0	5	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	035	0	1	01	01	H2012_035_0	5	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								9.00		27.00					4.00		12.00											9.00		27.00				4.00		0.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	035	0	1	01	01	H2012_035_0	5	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								9.00		27.00					4.00		12.00											9.00		27.00				4.00		0.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	035	0	1	01	01	H2012_035_0	5	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	035	0	1	01	01	H2012_035_0	5	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	035	0	1	01	01	H2012_035_0	5	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	035	0	1	01	01	H2012_035_0	5	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	035	0	1	01	01	H2012_035_0	5	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	035	0	1	01	01	H2012_035_0	5	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	035	0	1	01	01	H2012_035_0	5	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	035	0	1	01	01	H2012_035_0	5	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	037	0	1	01	01	H2012_037_0	5	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								9.00		27.00					4.00		12.00											9.00		27.00				4.00		0.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	037	0	1	01	01	H2012_037_0	5	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								9.00		27.00					4.00		12.00											9.00		27.00				4.00		0.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	037	0	1	01	01	H2012_037_0	5	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	037	0	1	01	01	H2012_037_0	5	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	037	0	1	01	01	H2012_037_0	5	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	037	0	1	01	01	H2012_037_0	5	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	037	0	1	01	01	H2012_037_0	5	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	037	0	1	01	01	H2012_037_0	5	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	037	0	1	01	01	H2012_037_0	5	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	037	0	1	01	01	H2012_037_0	5	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	039	0	1	01	01	H2012_039_0	6	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								9.00		27.00					4.00		12.00											9.00		27.00				4.00		0.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	039	0	1	01	01	H2012_039_0	6	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								9.00		27.00					4.00		12.00											9.00		27.00				4.00		0.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	039	0	1	01	01	H2012_039_0	6	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	039	0	1	01	01	H2012_039_0	6	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	039	0	1	01	01	H2012_039_0	6	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	039	0	1	01	01	H2012_039_0	6	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	039	0	1	01	01	H2012_039_0	6	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	039	0	1	01	01	H2012_039_0	6	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	039	0	1	01	01	H2012_039_0	6	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	039	0	1	01	01	H2012_039_0	6	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	042	0	1	01	01	H2012_042_0	5	Preferred Generic	3	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	042	0	1	01	01	H2012_042_0	5	Generic	3	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					19.00		57.00											20.00		60.00				19.00		0.00				20.00				20.00			0.67	0.63		0.67	0.63	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	042	0	1	01	01	H2012_042_0	5	Preferred Brand	3	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	042	0	1	01	01	H2012_042_0	5	Non-Preferred Drug	3	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	042	0	1	01	01	H2012_042_0	5	Specialty Tier	3	010010	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	053	0	1	01	01	H2012_053_0	4	Preferred Generic	3	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	053	0	1	01	01	H2012_053_0	4	Generic	3	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	053	0	1	01	01	H2012_053_0	4	Preferred Brand	3	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	053	0	1	01	01	H2012_053_0	4	Non-Preferred Drug	3	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	053	0	1	01	01	H2012_053_0	4	Specialty Tier	3	010010	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												
H2012	054	0	1	01	01	H2012_054_0	4	Preferred Generic	3	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	054	0	1	01	01	H2012_054_0	4	Generic	3	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								8.00		24.00					3.00		9.00											8.00		24.00				3.00		0.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	054	0	1	01	01	H2012_054_0	4	Preferred Brand	3	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	054	0	1	01	01	H2012_054_0	4	Non-Preferred Drug	3	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	054	0	1	01	01	H2012_054_0	4	Specialty Tier	3	010010	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												
H2012	055	0	1	01	01	H2012_055_0	5	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					9.00		27.00											10.00		30.00				9.00		0.00				10.00				10.00			0.33	0.30		0.33	0.30	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	055	0	1	01	01	H2012_055_0	5	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					9.00		27.00											10.00		30.00				9.00		0.00				10.00				10.00			0.33	0.30		0.33	0.30	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	055	0	1	01	01	H2012_055_0	5	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	055	0	1	01	01	H2012_055_0	5	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	055	0	1	01	01	H2012_055_0	5	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	055	0	1	01	01	H2012_055_0	5	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	055	0	1	01	01	H2012_055_0	5	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	055	0	1	01	01	H2012_055_0	5	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	055	0	1	01	01	H2012_055_0	5	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	055	0	1	01	01	H2012_055_0	5	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	056	0	1	01	01	H2012_056_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	056	0	1	01	01	H2012_056_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	056	0	1	01	01	H2012_056_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	056	0	1	01	01	H2012_056_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	056	0	1	01	01	H2012_056_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	056	0	1	01	01	H2012_056_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	056	0	1	01	01	H2012_056_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	056	0	1	01	01	H2012_056_0	4	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	056	0	1	01	01	H2012_056_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	056	0	1	01	01	H2012_056_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	060	0	1	01	01	H2012_060_0	5	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2012	060	0	1	01	01	H2012_060_0	5	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H2012	060	0	1	01	01	H2012_060_0	5	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2012	060	0	1	01	01	H2012_060_0	5	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H2012	060	0	1	01	01	H2012_060_0	5	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				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												
H2012	060	0	1	01	01	H2012_060_0	5	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H2012	060	0	1	01	01	H2012_060_0	5	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2012	060	0	1	01	01	H2012_060_0	5	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H2012	060	0	1	01	01	H2012_060_0	5	Specialty Tier	4	010010	1	1	5	1		010	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												
H2012	060	0	1	01	01	H2012_060_0	5	Specialty Tier	4	010010	1	1	5	3		010	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										2	3	
H2012	060	0	1	01	01	H2012_060_0	5	Select Care Drugs	4	010010	1	2	6	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2012	064	0	1	01	01	H2012_064_0	5	Preferred Generic	3	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	064	0	1	01	01	H2012_064_0	5	Generic	3	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					19.00		57.00											20.00		60.00				19.00		0.00				20.00				20.00			0.67	0.63		0.67	0.63	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	064	0	1	01	01	H2012_064_0	5	Preferred Brand	3	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	064	0	1	01	01	H2012_064_0	5	Non-Preferred Drug	3	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	064	0	1	01	01	H2012_064_0	5	Specialty Tier	3	010010	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												
H2012	070	0	1	01	01	H2012_070_0	4	Preferred Generic	3	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	070	0	1	01	01	H2012_070_0	4	Generic	3	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								11.00		33.00					6.00		18.00											11.00		33.00				6.00		0.00				11.00				11.00			0.37	0.20		0.37	0.20	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	070	0	1	01	01	H2012_070_0	4	Preferred Brand	3	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	070	0	1	01	01	H2012_070_0	4	Non-Preferred Drug	3	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	070	0	1	01	01	H2012_070_0	4	Specialty Tier	3	010010	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												
H2012	080	0	1	01	01	H2012_080_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	080	0	1	01	01	H2012_080_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	080	0	1	01	01	H2012_080_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								16.00		48.00					11.00		33.00											16.00		48.00				11.00		0.00				16.00				16.00			0.53	0.37		0.53	0.37	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	080	0	1	01	01	H2012_080_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								16.00		48.00					11.00		33.00											16.00		48.00				11.00		0.00				16.00				16.00			0.53	0.37		0.53	0.37	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	080	0	1	01	01	H2012_080_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	080	0	1	01	01	H2012_080_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	080	0	1	01	01	H2012_080_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	080	0	1	01	01	H2012_080_0	4	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	080	0	1	01	01	H2012_080_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	080	0	1	01	01	H2012_080_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	082	0	1	01	01	H2012_082_0	5	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	082	0	1	01	01	H2012_082_0	5	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	082	0	1	01	01	H2012_082_0	5	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								16.00		48.00					11.00		33.00											16.00		48.00				11.00		0.00				16.00				16.00			0.53	0.37		0.53	0.37	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	082	0	1	01	01	H2012_082_0	5	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								16.00		48.00					11.00		33.00											16.00		48.00				11.00		0.00				16.00				16.00			0.53	0.37		0.53	0.37	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	082	0	1	01	01	H2012_082_0	5	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	082	0	1	01	01	H2012_082_0	5	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	082	0	1	01	01	H2012_082_0	5	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	082	0	1	01	01	H2012_082_0	5	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	082	0	1	01	01	H2012_082_0	5	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	082	0	1	01	01	H2012_082_0	5	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	084	0	1	01	01	H2012_084_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2012	084	0	1	01	01	H2012_084_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H2012	084	0	1	01	01	H2012_084_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2012	084	0	1	01	01	H2012_084_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H2012	084	0	1	01	01	H2012_084_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				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												
H2012	084	0	1	01	01	H2012_084_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H2012	084	0	1	01	01	H2012_084_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2012	084	0	1	01	01	H2012_084_0	4	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H2012	084	0	1	01	01	H2012_084_0	4	Specialty Tier	4	010010	1	1	5	1		010	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												
H2012	084	0	1	01	01	H2012_084_0	4	Specialty Tier	4	010010	1	1	5	3		010	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										2	3	
H2012	084	0	1	01	01	H2012_084_0	4	Select Care Drugs	4	010010	1	2	6	1		110	01		110	1				30		90	2	2				30		90	30		31								11.00		33.00					7.00		21.00											11.00		33.00				7.00		0.00				11.00				11.00			0.37	0.23		0.37	0.23	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2012	087	0	1	01	01	H2012_087_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	087	0	1	01	01	H2012_087_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	087	0	1	01	01	H2012_087_0	3	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	087	0	1	01	01	H2012_087_0	3	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	087	0	1	01	01	H2012_087_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	087	0	1	01	01	H2012_087_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	087	0	1	01	01	H2012_087_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	087	0	1	01	01	H2012_087_0	3	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	087	0	1	01	01	H2012_087_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	087	0	1	01	01	H2012_087_0	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	088	0	1	01	01	H2012_088_0	5	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								8.00		24.00					3.00		9.00											8.00		24.00				3.00		0.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	088	0	1	01	01	H2012_088_0	5	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								8.00		24.00					3.00		9.00											8.00		24.00				3.00		0.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	088	0	1	01	01	H2012_088_0	5	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	088	0	1	01	01	H2012_088_0	5	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	088	0	1	01	01	H2012_088_0	5	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	088	0	1	01	01	H2012_088_0	5	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	088	0	1	01	01	H2012_088_0	5	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	088	0	1	01	01	H2012_088_0	5	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	088	0	1	01	01	H2012_088_0	5	Specialty Tier	4	010010	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												
H2012	088	0	1	01	01	H2012_088_0	5	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	090	0	1	01	01	H2012_090_0	5	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								8.00		24.00					3.00		9.00											8.00		24.00				3.00		0.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	090	0	1	01	01	H2012_090_0	5	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								8.00		24.00					3.00		9.00											8.00		24.00				3.00		0.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	090	0	1	01	01	H2012_090_0	5	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	090	0	1	01	01	H2012_090_0	5	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	090	0	1	01	01	H2012_090_0	5	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	090	0	1	01	01	H2012_090_0	5	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	090	0	1	01	01	H2012_090_0	5	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	090	0	1	01	01	H2012_090_0	5	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	090	0	1	01	01	H2012_090_0	5	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	090	0	1	01	01	H2012_090_0	5	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	095	0	1	01	01	H2012_095_0	5	Preferred Generic	3	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	095	0	1	01	01	H2012_095_0	5	Generic	3	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					16.00		48.00											20.00		60.00				16.00		0.00				20.00				20.00			0.67	0.53		0.67	0.53	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	095	0	1	01	01	H2012_095_0	5	Preferred Brand	3	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	095	0	1	01	01	H2012_095_0	5	Non-Preferred Drug	3	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	095	0	1	01	01	H2012_095_0	5	Specialty Tier	3	010010	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	096	0	1	01	01	H2012_096_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	096	0	1	01	01	H2012_096_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	096	0	1	01	01	H2012_096_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	096	0	1	01	01	H2012_096_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	096	0	1	01	01	H2012_096_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	096	0	1	01	01	H2012_096_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	096	0	1	01	01	H2012_096_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	096	0	1	01	01	H2012_096_0	4	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	096	0	1	01	01	H2012_096_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	096	0	1	01	01	H2012_096_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	097	0	1	01	01	H2012_097_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	097	0	1	01	01	H2012_097_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	097	0	1	01	01	H2012_097_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	097	0	1	01	01	H2012_097_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	097	0	1	01	01	H2012_097_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	097	0	1	01	01	H2012_097_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	097	0	1	01	01	H2012_097_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	097	0	1	01	01	H2012_097_0	4	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	097	0	1	01	01	H2012_097_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	097	0	1	01	01	H2012_097_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	099	1	1	01	01	H2012_099_1	5	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	099	1	1	01	01	H2012_099_1	5	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	099	1	1	01	01	H2012_099_1	5	Generic	4	010001	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								16.00		48.00					11.00		33.00											16.00		48.00				11.00		0.00				16.00				16.00			0.53	0.37		0.53	0.37	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	099	1	1	01	01	H2012_099_1	5	Generic	4	010001	3	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								16.00		48.00					11.00		33.00											16.00		48.00				11.00		0.00				16.00				16.00			0.53	0.37		0.53	0.37	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	3
H2012	099	1	1	01	01	H2012_099_1	5	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	099	1	1	01	01	H2012_099_1	5	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	099	1	1	01	01	H2012_099_1	5	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	099	1	1	01	01	H2012_099_1	5	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	099	1	1	01	01	H2012_099_1	5	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	099	1	1	01	01	H2012_099_1	5	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	099	2	1	01	01	H2012_099_2	5	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	099	2	1	01	01	H2012_099_2	5	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	099	2	1	01	01	H2012_099_2	5	Generic	4	010001	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								16.00		48.00					11.00		33.00											16.00		48.00				11.00		0.00				16.00				16.00			0.53	0.37		0.53	0.37	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	099	2	1	01	01	H2012_099_2	5	Generic	4	010001	3	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								16.00		48.00					11.00		33.00											16.00		48.00				11.00		0.00				16.00				16.00			0.53	0.37		0.53	0.37	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	3
H2012	099	2	1	01	01	H2012_099_2	5	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	099	2	1	01	01	H2012_099_2	5	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	099	2	1	01	01	H2012_099_2	5	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	099	2	1	01	01	H2012_099_2	5	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	099	2	1	01	01	H2012_099_2	5	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	099	2	1	01	01	H2012_099_2	5	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	100	4	1	01	01	H2012_100_4	6	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	100	4	1	01	01	H2012_100_4	6	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	100	4	1	01	01	H2012_100_4	6	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	100	4	1	01	01	H2012_100_4	6	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	100	4	1	01	01	H2012_100_4	6	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	100	4	1	01	01	H2012_100_4	6	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	100	4	1	01	01	H2012_100_4	6	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	100	4	1	01	01	H2012_100_4	6	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	100	4	1	01	01	H2012_100_4	6	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	100	4	1	01	01	H2012_100_4	6	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	100	5	1	01	01	H2012_100_5	6	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	100	5	1	01	01	H2012_100_5	6	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	100	5	1	01	01	H2012_100_5	6	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	100	5	1	01	01	H2012_100_5	6	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	100	5	1	01	01	H2012_100_5	6	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	100	5	1	01	01	H2012_100_5	6	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	100	5	1	01	01	H2012_100_5	6	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	100	5	1	01	01	H2012_100_5	6	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	100	5	1	01	01	H2012_100_5	6	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	100	5	1	01	01	H2012_100_5	6	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	101	1	1	01	01	H2012_101_1	5	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	101	1	1	01	01	H2012_101_1	5	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	101	1	1	01	01	H2012_101_1	5	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	101	1	1	01	01	H2012_101_1	5	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	101	1	1	01	01	H2012_101_1	5	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	101	1	1	01	01	H2012_101_1	5	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	101	1	1	01	01	H2012_101_1	5	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	101	1	1	01	01	H2012_101_1	5	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	101	1	1	01	01	H2012_101_1	5	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	101	1	1	01	01	H2012_101_1	5	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	101	2	1	01	01	H2012_101_2	5	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	101	2	1	01	01	H2012_101_2	5	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	101	2	1	01	01	H2012_101_2	5	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	101	2	1	01	01	H2012_101_2	5	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	101	2	1	01	01	H2012_101_2	5	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	101	2	1	01	01	H2012_101_2	5	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	101	2	1	01	01	H2012_101_2	5	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	101	2	1	01	01	H2012_101_2	5	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	101	2	1	01	01	H2012_101_2	5	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	101	2	1	01	01	H2012_101_2	5	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	102	0	1	01	01	H2012_102_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	102	0	1	01	01	H2012_102_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	102	0	1	01	01	H2012_102_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	102	0	1	01	01	H2012_102_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	102	0	1	01	01	H2012_102_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	102	0	1	01	01	H2012_102_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	102	0	1	01	01	H2012_102_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	102	0	1	01	01	H2012_102_0	4	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	102	0	1	01	01	H2012_102_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	102	0	1	01	01	H2012_102_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	103	0	1	01	01	H2012_103_0	3	Preferred Generic	3	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	103	0	1	01	01	H2012_103_0	3	Generic	3	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								19.00		57.00					14.00		42.00											19.00		57.00				14.00		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												
H2012	103	0	1	01	01	H2012_103_0	3	Preferred Brand	3	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	103	0	1	01	01	H2012_103_0	3	Non-Preferred Drug	3	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	103	0	1	01	01	H2012_103_0	3	Specialty Tier	3	010010	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												
H2012	104	0	1	01	01	H2012_104_0	3	Preferred Generic	3	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	104	0	1	01	01	H2012_104_0	3	Generic	3	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								18.00		54.00					13.00		39.00											18.00		54.00				13.00		0.00				18.00				18.00			0.60	0.43		0.60	0.43	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	104	0	1	01	01	H2012_104_0	3	Preferred Brand	3	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	104	0	1	01	01	H2012_104_0	3	Non-Preferred Drug	3	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	104	0	1	01	01	H2012_104_0	3	Specialty Tier	3	010010	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												
H2012	105	0	1	01	01	H2012_105_0	3	Preferred Generic	3	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								6.00		18.00					1.00		3.00											6.00		18.00				1.00		0.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	105	0	1	01	01	H2012_105_0	3	Generic	3	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								16.00		48.00					11.00		33.00											16.00		48.00				11.00		0.00				16.00				16.00			0.53	0.37		0.53	0.37	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	105	0	1	01	01	H2012_105_0	3	Preferred Brand	3	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	105	0	1	01	01	H2012_105_0	3	Non-Preferred Drug	3	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	105	0	1	01	01	H2012_105_0	3	Specialty Tier	3	010010	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	106	0	1	01	01	H2012_106_0	5	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								9.00		27.00					4.00		12.00											9.00		27.00				4.00		0.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	106	0	1	01	01	H2012_106_0	5	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								9.00		27.00					4.00		12.00											9.00		27.00				4.00		0.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	106	0	1	01	01	H2012_106_0	5	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	106	0	1	01	01	H2012_106_0	5	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	106	0	1	01	01	H2012_106_0	5	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	106	0	1	01	01	H2012_106_0	5	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	106	0	1	01	01	H2012_106_0	5	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	106	0	1	01	01	H2012_106_0	5	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	106	0	1	01	01	H2012_106_0	5	Specialty Tier	4	010010	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												
H2012	106	0	1	01	01	H2012_106_0	5	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	107	0	1	01	01	H2012_107_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								8.00		24.00					3.00		9.00											8.00		24.00				3.00		0.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	107	0	1	01	01	H2012_107_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								8.00		24.00					3.00		9.00											8.00		24.00				3.00		0.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	107	0	1	01	01	H2012_107_0	3	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	107	0	1	01	01	H2012_107_0	3	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	107	0	1	01	01	H2012_107_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	107	0	1	01	01	H2012_107_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	107	0	1	01	01	H2012_107_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	107	0	1	01	01	H2012_107_0	3	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	107	0	1	01	01	H2012_107_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	107	0	1	01	01	H2012_107_0	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	108	0	1	01	01	H2012_108_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								8.00		24.00					3.00		9.00											8.00		24.00				3.00		0.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	108	0	1	01	01	H2012_108_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								8.00		24.00					3.00		9.00											8.00		24.00				3.00		0.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	108	0	1	01	01	H2012_108_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	108	0	1	01	01	H2012_108_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	108	0	1	01	01	H2012_108_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	108	0	1	01	01	H2012_108_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	108	0	1	01	01	H2012_108_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2012	108	0	1	01	01	H2012_108_0	4	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	108	0	1	01	01	H2012_108_0	4	Specialty Tier	4	010010	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												
H2012	108	0	1	01	01	H2012_108_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2012	109	0	1	01	01	H2012_109_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2012	109	0	1	01	01	H2012_109_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H2012	109	0	1	01	01	H2012_109_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2012	109	0	1	01	01	H2012_109_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H2012	109	0	1	01	01	H2012_109_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				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												
H2012	109	0	1	01	01	H2012_109_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H2012	109	0	1	01	01	H2012_109_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2012	109	0	1	01	01	H2012_109_0	4	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H2012	109	0	1	01	01	H2012_109_0	4	Specialty Tier	4	010010	1	1	5	1		010	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												
H2012	109	0	1	01	01	H2012_109_0	4	Specialty Tier	4	010010	1	1	5	3		010	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										2	3	
H2012	109	0	1	01	01	H2012_109_0	4	Select Care Drugs	4	010010	1	2	6	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2029	001	0	1	04	01	H2029_001_0	4	Preferred Generic	4	001010	1	2	1	1	110		01		110	1	30		90				2	2				30		90	30		31	3.00		9.00																									3.00		9.00				3.00		0.00				3.00				3.00		0.10				0.10	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2029	001	0	1	04	01	H2029_001_0	4	Preferred Generic	4	001010	1	2	1	3	110		01		110	1	30		90				2	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										2	3	
H2029	001	0	1	04	01	H2029_001_0	4	Generic	4	010001	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		0.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2029	001	0	1	04	01	H2029_001_0	4	Generic	4	010001	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2029	001	0	1	04	01	H2029_001_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		131.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2029	001	0	1	04	01	H2029_001_0	4	Preferred Brand	4	010001	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										2	3	
H2029	001	0	1	04	01	H2029_001_0	4	Non-Preferred Drug	4	110000	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2029	001	0	1	04	01	H2029_001_0	4	Non-Preferred Drug	4	110000	1	2	4	3	110		01		110	1	30		90				2	2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		287.00				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2029	001	0	1	04	01	H2029_001_0	4	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2029	001	0	1	04	01	H2029_001_0	4	Specialty Tier	4	010010	1	1	5	3	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2108	022	0	1	01	01	H2108_022_0	7	Preferred Generic	4	001000	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		31								12.00	24.00	30.00					7.00	14.00	17.50					12.00		30.00																12.00				12.00			0.40	0.23	0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2108	022	0	1	01	01	H2108_022_0	7	Generic	4	010000	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		31								20.00	40.00	50.00					15.00	30.00	37.50					20.00		50.00																20.00				20.00			0.67	0.50	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2108	022	0	1	01	01	H2108_022_0	7	Preferred Brand	4	000101	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					47.00		141.00																47.00				47.00			1.57	1.40	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2108	022	0	1	01	01	H2108_022_0	7	Non-Preferred Drug	4	100100	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		31								95.00	190.00	285.00					90.00	180.00	270.00					95.00		285.00																95.00				95.00			3.17	3.00	3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2108	022	0	1	01	01	H2108_022_0	7	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		31											433.99	27						447.48	27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2108	028	0	1	01	01	H2108_028_0	7	Preferred Generic	4	001000	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		31								12.00	24.00	30.00					7.00	14.00	17.50					12.00		30.00																12.00				12.00			0.40	0.23	0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2108	028	0	1	01	01	H2108_028_0	7	Generic	4	010000	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		31								20.00	40.00	50.00					15.00	30.00	37.50					20.00		50.00																20.00				20.00			0.67	0.50	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2108	028	0	1	01	01	H2108_028_0	7	Preferred Brand	4	000101	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					47.00		141.00																47.00				47.00			1.57	1.40	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2108	028	0	1	01	01	H2108_028_0	7	Non-Preferred Drug	4	100100	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		31								95.00	190.00	285.00					90.00	180.00	270.00					95.00		285.00																95.00				95.00			3.17	3.00	3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2108	028	0	1	01	01	H2108_028_0	7	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		31											405.70	27						413.89	27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2108	029	0	1	01	01	H2108_029_0	7	Preferred Generic	4	001000	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		31								12.00	24.00	30.00					7.00	14.00	17.50					12.00		30.00																12.00				12.00			0.40	0.23	0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H2108	029	0	1	01	01	H2108_029_0	7	Generic	4	010000	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		31								20.00	40.00	50.00					15.00	30.00	37.50					20.00		50.00																20.00				20.00			0.67	0.50	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H2108	029	0	1	01	01	H2108_029_0	7	Preferred Brand	4	000101	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					47.00		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 Diabetic Drugs												
H2108	029	0	1	01	01	H2108_029_0	7	Non-Preferred Drug	4	100100	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		31								95.00	190.00	285.00					90.00	180.00	270.00					95.00		285.00																95.00				95.00			3.17	3.00	3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H2108	029	0	1	01	01	H2108_029_0	7	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		31											317.42	27						244.30	27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H2108	029	0	1	01	01	H2108_029_0	7	Select Diabetic Drugs	4	010010	1	2	6	1		111	01	110		1				30	60	90	1	2	30		90				30		31								6.00	12.00	15.00					5.00	10.00	12.50					6.00		15.00																6.00				6.00			0.20	0.17	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H2108	030	0	1	01	01	H2108_030_0	7	Preferred Generic	4	001000	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		31								12.00	24.00	30.00					7.00	14.00	17.50					12.00		30.00																12.00				12.00			0.40	0.23	0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H2108	030	0	1	01	01	H2108_030_0	7	Generic	4	010000	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		31								20.00	40.00	50.00					15.00	30.00	37.50					20.00		50.00																20.00				20.00			0.67	0.50	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H2108	030	0	1	01	01	H2108_030_0	7	Preferred Brand	4	000101	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					47.00		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 Diabetic Drugs												
H2108	030	0	1	01	01	H2108_030_0	7	Non-Preferred Drug	4	100100	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		31								95.00	190.00	285.00					90.00	180.00	270.00					95.00		285.00																95.00				95.00			3.17	3.00	3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H2108	030	0	1	01	01	H2108_030_0	7	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		31											353.16	27						405.94	27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H2108	030	0	1	01	01	H2108_030_0	7	Select Diabetic Drugs	4	010010	1	2	6	1		111	01	110		1				30	60	90	1	2	30		90				30		31								11.00	22.00	27.50					10.00	20.00	25.00					11.00		27.50																11.00				11.00			0.37	0.33	0.37			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H2108	032	0	1	01	01	H2108_032_0	7	Preferred Generic	4	001000	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		31								12.00	24.00	30.00					7.00	14.00	17.50					12.00		30.00																12.00				12.00			0.40	0.23	0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2108	032	0	1	01	01	H2108_032_0	7	Generic	4	010000	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		31								20.00	40.00	50.00					15.00	30.00	37.50					20.00		50.00																20.00				20.00			0.67	0.50	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2108	032	0	1	01	01	H2108_032_0	7	Preferred Brand	4	000101	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					47.00		141.00																47.00				47.00			1.57	1.40	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2108	032	0	1	01	01	H2108_032_0	7	Non-Preferred Drug	4	100100	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		31								95.00	190.00	285.00					90.00	180.00	270.00					95.00		285.00																95.00				95.00			3.17	3.00	3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2108	032	0	1	01	01	H2108_032_0	7	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		31											407.53	27						432.35	27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2108	033	0	1	01	01	H2108_033_0	7	Preferred Generic	4	001000	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		31								12.00	24.00	30.00					7.00	14.00	17.50					12.00		30.00																12.00				12.00			0.40	0.23	0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2108	033	0	1	01	01	H2108_033_0	7	Generic	4	010000	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		31								20.00	40.00	50.00					15.00	30.00	37.50					20.00		50.00																20.00				20.00			0.67	0.50	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2108	033	0	1	01	01	H2108_033_0	7	Preferred Brand	4	000101	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					47.00		141.00																47.00				47.00			1.57	1.40	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2108	033	0	1	01	01	H2108_033_0	7	Non-Preferred Drug	4	100100	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		31								95.00	190.00	285.00					90.00	180.00	270.00					95.00		285.00																95.00				95.00			3.17	3.00	3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2108	033	0	1	01	01	H2108_033_0	7	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		31											433.99	27						447.48	27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2150	002	0	1	18	06	H2150_002_0	6	Preferred Generic	4	001000	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.16		0.33	0.16	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2150	002	0	1	18	06	H2150_002_0	6	Preferred Generic	4	001000	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.16		0.33	0.16	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H2150	002	0	1	18	06	H2150_002_0	6	Generic	4	010000	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		30.00				20.00				20.00			0.66	0.50		0.66	0.50	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2150	002	0	1	18	06	H2150_002_0	6	Generic	4	010000	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		30.00				20.00				20.00			0.66	0.50		0.66	0.50	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H2150	002	0	1	18	06	H2150_002_0	6	Preferred Brand	4	000001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		84.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2150	002	0	1	18	06	H2150_002_0	6	Non-Preferred Brand	4	100000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					80.00		240.00											100.00		300.00				80.00		160.00				100.00				100.00			3.33	2.66		3.33	2.66	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2150	002	0	1	18	06	H2150_002_0	6	Specialty Tier	4	010010	1	1	5	1		110	01		110	1				30		90	2	2				30		90	30		31											1586.00	33		33				1586.00	33		33										33		33				33		33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2150	002	0	1	18	06	H2150_002_0	6	Vaccines	4	000001	1	2	6	1		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2150	002	0	1	18	06	H2150_002_0	6	Vaccines	4	000001	1	2	6	3		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H2150	009	0	1	18	06	H2150_009_0	6	Preferred Generic	4	001000	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2150	009	0	1	18	06	H2150_009_0	6	Generic	4	010000	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		30.00				20.00				20.00			0.66	0.50		0.66	0.50	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2150	009	0	1	18	06	H2150_009_0	6	Preferred Brand	4	000001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		84.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2150	009	0	1	18	06	H2150_009_0	6	Non-Preferred Brand	4	100000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		190.00				100.00				100.00			3.33	3.16		3.33	3.16	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2150	009	0	1	18	06	H2150_009_0	6	Specialty Tier	4	010010	1	1	5	1		110	01		110	1				30		90	2	2				30		90	30		31											1848.00	33		33				1848.00	33		33										33		33				33		33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2150	009	0	1	18	06	H2150_009_0	6	Vaccines	4	000001	1	2	6	1		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2150	009	0	1	18	06	H2150_009_0	6	Vaccines	4	000001	1	2	6	3		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H2150	029	0	2	18	06	H2150_029_0	7	Preferred Generic	4	001000	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2150	029	0	2	18	06	H2150_029_0	7	Generic	4	010000	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		30.00				20.00				20.00			0.66	0.50		0.66	0.50	0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2150	029	0	2	18	06	H2150_029_0	7	Preferred Brand	4	000001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		84.00				47.00				47.00			1.56	1.40		1.56	1.40	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2150	029	0	2	18	06	H2150_029_0	7	Non-Preferred Brand	4	100000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		190.00				100.00				100.00			3.33	3.16		3.33	3.16	3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2150	029	0	2	18	06	H2150_029_0	7	Specialty Tier	4	010010	1	1	5	1		110	01		110	1				30		90	2	2				30		90	30		31											1774.00	33		33				1774.00	33		33										33		33				33		33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2150	029	0	2	18	06	H2150_029_0	7	Vaccines	4	000001	1	2	6	1		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H2150	029	0	2	18	06	H2150_029_0	7	Vaccines	4	000001	1	2	6	3		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H2161	002	0	1	01	01	H2161_002_0	3	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	10.00																			5.00	7.50	7.50																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2161	002	0	1	01	01	H2161_002_0	3	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	20.00																			10.00	15.00	15.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2161	002	0	1	01	01	H2161_002_0	3	Preferred Brand	4	000001	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	42.00	84.00	84.00																			42.00	63.00	63.00																42.00				42.00		1.40			1.40			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2161	002	0	1	01	01	H2161_002_0	3	Non-Preferred Brand	4	100000	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	190.00																			95.00	142.50	142.50																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2161	002	0	1	01	01	H2161_002_0	3	Specialty Tier	4	100000	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												
H2165	005	0	1	01	01	H2165_005_0	4	Preferred Generic	4	001000	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		31								8.00	16.00	16.00					3.00	6.00	6.00					8.00		16.00																8.00				8.00			0.27	0.10	0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2165	005	0	1	01	01	H2165_005_0	4	Preferred Generic	4	001000	1	2	1	3		111	01	110		1				30	60	90	1	2	30		90				30		31								8.00	16.00	16.00					3.00	6.00	6.00					8.00		16.00																8.00				8.00			0.27	0.10	0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2165	005	0	1	01	01	H2165_005_0	4	Generic	4	010000	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		31								17.00	34.00	34.00					12.00	24.00	24.00					17.00		34.00																17.00				17.00			0.57	0.40	0.57			0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2165	005	0	1	01	01	H2165_005_0	4	Preferred Brand	4	000101	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					47.00		141.00																47.00				47.00			1.57	1.40	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2165	005	0	1	01	01	H2165_005_0	4	Non-Preferred Drug	4	100100	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00		300.00																100.00				100.00			3.33	3.17	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2165	005	0	1	01	01	H2165_005_0	4	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		31											442.95	29						271.61	29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2165	018	0	1	01	01	H2165_018_0	5	Preferred Generic	4	001000	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		31								8.00	16.00	20.00					3.00	6.00	7.50					8.00		20.00																8.00				8.00			0.27	0.10	0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2165	018	0	1	01	01	H2165_018_0	5	Generic	4	010000	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		31								13.00	26.00	32.50					8.00	16.00	20.00					13.00		32.50																13.00				13.00			0.43	0.27	0.43			0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2165	018	0	1	01	01	H2165_018_0	5	Preferred Brand	4	000101	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		31								40.00	80.00	120.00					35.00	70.00	105.00					40.00		120.00																40.00				40.00			1.33	1.17	1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2165	018	0	1	01	01	H2165_018_0	5	Non-Preferred Drug	4	100100	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		31								75.00	150.00	225.00					70.00	140.00	210.00					75.00		225.00																75.00				75.00			2.50	2.33	2.50			2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2165	018	0	1	01	01	H2165_018_0	5	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		31											542.90	33						437.07	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2171	001	0	1	01	01	H2171_001_0	8	Preferred Generic	4	001000	1	2	1	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2171	001	0	1	01	01	H2171_001_0	8	Generic	4	010010	1	2	2	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	8.00	16.00	16.00																			8.00	16.00	16.00																	8.00			8.00		0.27			0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2171	001	0	1	01	01	H2171_001_0	8	Preferred Brand	4	010001	1	2	3	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	40.00	80.00	80.00																			40.00	80.00	80.00																	40.00			40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2171	001	0	1	01	01	H2171_001_0	8	Non-Preferred Drug	4	110000	1	2	4	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	90.00	180.00	180.00																			90.00	180.00	180.00																	90.00			90.00		3.00			3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2171	001	0	1	01	01	H2171_001_0	8	Specialty Tier	4	010010	1	1	5	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31				933.29	33	33	33																		33	33	33																33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	011	0	1	04	01	H2228_011_0	8	Preferred Generic	3	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	011	0	1	04	01	H2228_011_0	8	Generic	3	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		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	8	Preferred Brand	3	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		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	8	Non-Preferred Drug	3	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		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	8	Specialty Tier	3	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				787.00	31		31																										31						31			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	012	0	1	04	01	H2228_012_0	7	Preferred Generic	3	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	012	0	1	04	01	H2228_012_0	7	Generic	3	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		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	012	0	1	04	01	H2228_012_0	7	Preferred Brand	3	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		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	012	0	1	04	01	H2228_012_0	7	Non-Preferred Drug	3	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		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	012	0	1	04	01	H2228_012_0	7	Specialty Tier	3	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				787.00	31		31																										31						31			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	017	0	1	04	01	H2228_017_0	7	Preferred Generic	3	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	017	0	1	04	01	H2228_017_0	7	Generic	3	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		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	7	Preferred Brand	3	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		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	7	Non-Preferred Drug	3	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		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	7	Specialty Tier	3	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				828.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	018	0	1	04	01	H2228_018_0	6	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	018	0	1	04	01	H2228_018_0	6	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	018	0	1	04	01	H2228_018_0	6	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	018	0	1	04	01	H2228_018_0	6	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	018	0	1	04	01	H2228_018_0	6	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				826.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	019	0	1	04	01	H2228_019_0	7	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	019	0	1	04	01	H2228_019_0	7	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	019	0	1	04	01	H2228_019_0	7	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		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	7	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		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	7	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				676.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	020	0	1	04	01	H2228_020_0	7	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	020	0	1	04	01	H2228_020_0	7	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	020	0	1	04	01	H2228_020_0	7	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		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	7	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		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	7	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				594.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	021	0	1	04	01	H2228_021_0	7	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	021	0	1	04	01	H2228_021_0	7	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	021	0	1	04	01	H2228_021_0	7	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		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	7	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		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	7	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				652.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	022	0	1	04	01	H2228_022_0	7	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	022	0	1	04	01	H2228_022_0	7	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	022	0	1	04	01	H2228_022_0	7	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		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	7	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		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	7	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				787.00	30		30																										30						30			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	023	0	1	04	01	H2228_023_0	7	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	023	0	1	04	01	H2228_023_0	7	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	023	0	1	04	01	H2228_023_0	7	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		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	7	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		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	7	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				963.00	26		26																										26						26			26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	024	0	1	04	01	H2228_024_0	6	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	024	0	1	04	01	H2228_024_0	6	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		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	024	0	1	04	01	H2228_024_0	6	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		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	6	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		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	6	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				720.00	27		27																										27						27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	029	0	1	04	01	H2228_029_0	6	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	029	0	1	04	01	H2228_029_0	6	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	029	0	1	04	01	H2228_029_0	6	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		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	6	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		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	6	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				751.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	030	0	1	04	01	H2228_030_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	030	0	1	04	01	H2228_030_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	030	0	1	04	01	H2228_030_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		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	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		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	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				807.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	031	0	1	04	01	H2228_031_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	031	0	1	04	01	H2228_031_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	031	0	1	04	01	H2228_031_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	031	0	1	04	01	H2228_031_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	031	0	1	04	01	H2228_031_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				642.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	032	0	1	04	01	H2228_032_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	032	0	1	04	01	H2228_032_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	032	0	1	04	01	H2228_032_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		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	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		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	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				574.00	30		30																										30						30			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	033	0	1	04	01	H2228_033_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	033	0	1	04	01	H2228_033_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	033	0	1	04	01	H2228_033_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		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	033	0	1	04	01	H2228_033_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		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	033	0	1	04	01	H2228_033_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				859.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	035	0	1	04	01	H2228_035_0	5	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	035	0	1	04	01	H2228_035_0	5	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	035	0	1	04	01	H2228_035_0	5	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	035	0	1	04	01	H2228_035_0	5	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	035	0	1	04	01	H2228_035_0	5	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				854.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	036	0	1	04	01	H2228_036_0	5	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	036	0	1	04	01	H2228_036_0	5	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	036	0	1	04	01	H2228_036_0	5	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	036	0	1	04	01	H2228_036_0	5	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	036	0	1	04	01	H2228_036_0	5	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				654.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	037	0	1	04	01	H2228_037_0	5	Preferred Generic	3	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	037	0	1	04	01	H2228_037_0	5	Generic	3	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	037	0	1	04	01	H2228_037_0	5	Preferred Brand	3	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		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	5	Non-Preferred Drug	3	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		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	5	Specialty Tier	3	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				834.00	26		26																										26						26			26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	039	0	1	04	01	H2228_039_0	7	Preferred Generic	3	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	039	0	1	04	01	H2228_039_0	7	Generic	3	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		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	7	Preferred Brand	3	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		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	7	Non-Preferred Drug	3	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		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	7	Specialty Tier	3	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				755.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	047	0	1	04	01	H2228_047_0	4	Preferred Generic	3	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	047	0	1	04	01	H2228_047_0	4	Generic	3	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	047	0	1	04	01	H2228_047_0	4	Preferred Brand	3	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		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	4	Non-Preferred Drug	3	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		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	4	Specialty Tier	3	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				833.00	27		27																										27						27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	048	0	1	04	01	H2228_048_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	048	0	1	04	01	H2228_048_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	048	0	1	04	01	H2228_048_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	048	0	1	04	01	H2228_048_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	048	0	1	04	01	H2228_048_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				789.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	049	0	1	04	01	H2228_049_0	4	Preferred Generic	3	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	049	0	1	04	01	H2228_049_0	4	Generic	3	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	049	0	1	04	01	H2228_049_0	4	Preferred Brand	3	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	049	0	1	04	01	H2228_049_0	4	Non-Preferred Drug	3	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2228	049	0	1	04	01	H2228_049_0	4	Specialty Tier	3	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				833.00	27		27																										27						27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2230	002	0	1	04	01	H2230_002_0	12	Preferred Generic	4	001000	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	2.00	2.00																2.00				2.00		.07			.07			.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2230	002	0	1	04	01	H2230_002_0	12	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	6.00	12.00	18.00																			6.00	12.00	12.00																6.00				6.00		.20			.20			.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2230	002	0	1	04	01	H2230_002_0	12	Preferred Brand	4	000001	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2230	002	0	1	04	01	H2230_002_0	12	Non-Preferred Brand	4	100000	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 Brand, Specialty Tier												
H2230	002	0	1	04	01	H2230_002_0	12	Specialty Tier	4	010010	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 Brand, Specialty Tier												
H2230	016	0	1	04	01	H2230_016_0	10	Preferred Generic	4	001000	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		.13			.13			.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2230	016	0	1	04	01	H2230_016_0	10	Generic	4	010000	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		.27			.27			.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2230	016	0	1	04	01	H2230_016_0	10	Preferred Brand	4	000001	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2230	016	0	1	04	01	H2230_016_0	10	Non-Preferred Brand	4	100000	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 Brand, Specialty Tier												
H2230	016	0	1	04	01	H2230_016_0	10	Specialty Tier	4	010010	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 Brand, Specialty Tier												
H2230	017	0	1	04	01	H2230_017_0	11	Preferred Generic	4	001000	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	6.00	6.00																6.00				6.00		0.20			0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2230	017	0	1	04	01	H2230_017_0	11	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	12.00	24.00	36.00																			12.00	24.00	24.00																12.00				12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2230	017	0	1	04	01	H2230_017_0	11	Preferred Brand	4	000001	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2230	017	0	1	04	01	H2230_017_0	11	Non-Preferred Brand	4	100000	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 Brand, Specialty Tier												
H2230	017	0	1	04	01	H2230_017_0	11	Specialty Tier	4	010010	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 Brand, Specialty Tier												
H2237	001	0	1	01	01	H2237_001_0	11	Generic	3	010000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	14.00	28.00	42.00																			14.00	28.00	42.00																14.00				14.00		0.47			0.47			0.45	Generic, Brand, Specialty Tier												
H2237	001	0	1	01	01	H2237_001_0	11	Brand	3	000010	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	43.00	86.00	129.00																			43.00	86.00	129.00																43.00				43.00		1.43			1.43			1.39	Generic, Brand, Specialty Tier												
H2237	001	0	1	01	01	H2237_001_0	11	Specialty Tier	3	010010	1	1	3	1	010		01	010		1	30								30						30		31				1.00	25																				25																	25			25								Generic, Brand, Specialty Tier												
H2237	007	0	1	01	01	H2237_007_0	12	Generic	3	010000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	11.00	22.00	33.00																			11.00	22.00	33.00																11.00				11.00		0.37			0.37			0.35	Generic, Brand, Specialty Tier												
H2237	007	0	1	01	01	H2237_007_0	12	Brand	3	000010	1	2	2	1	111		01	111		1	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	Generic, Brand, Specialty Tier												
H2237	007	0	1	01	01	H2237_007_0	12	Specialty Tier	3	010010	1	1	3	1	010		01	010		1	30								30						30		31				1.00	25																				25																	25			25								Generic, Brand, Specialty Tier												
H2237	009	0	1	01	01	H2237_009_0	11	Generic	3	010000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	14.00	28.00	42.00																			14.00	28.00	42.00																14.00				14.00		0.47			0.47			0.45	Generic, Brand, Specialty Tier												
H2237	009	0	1	01	01	H2237_009_0	11	Brand	3	000010	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	46.00	92.00	138.00																			46.00	92.00	138.00																46.00				46.00		1.53			1.53			1.48	Generic, Brand, Specialty Tier												
H2237	009	0	1	01	01	H2237_009_0	11	Specialty Tier	3	010010	1	1	3	1	010		01	010		1	30								30						30		31				1.00	25																				25																	25			25								Generic, Brand, Specialty Tier												
H2241	006	0	1	01	01	H2241_006_0	11	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	31		90				1	2			90				31		31	10.00		30.00																					20.00																10.00				10.00		.32						.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2241	006	0	1	01	01	H2241_006_0	11	Preferred Generic	4	001000	1	2	1	3	110		01	100		1	31		90				1	2			90				31		31	10.00		30.00																					20.00																10.00				10.00		.32						.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2241	006	0	1	01	01	H2241_006_0	11	Generic	4	010000	1	2	2	1	110		01	100		1	31		90				1	2			90				31		31	15.00		45.00																					30.00																15.00				15.00		.48						.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2241	006	0	1	01	01	H2241_006_0	11	Generic	4	010000	1	2	2	3	110		01	100		1	31		90				1	2			90				31		31	15.00		45.00																					30.00																15.00				15.00		.48						.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2241	006	0	1	01	01	H2241_006_0	11	Preferred Brand	4	010001	1	2	3	1	110		01	100		1	31		90				1	2			90				31		31	47.00		141.00																					94.00																47.00				47.00		1.52						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2241	006	0	1	01	01	H2241_006_0	11	Non-Preferred Brand	4	110000	1	2	4	1	110		01	100		1	31		90				1	2			90				31		31	100.00		300.00																					200.00																100.00				100.00		3.23						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2241	006	0	1	01	01	H2241_006_0	11	Specialty Tier	4	010010	1	1	5	1	110		01	100		1	31		90				1	2			90				31		31				120.78	33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2256	001	1	1	01	01	H2256_001_1	15	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2256	001	1	1	01	01	H2256_001_1	15	Preferred Generic	4	001000	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2256	001	1	1	01	01	H2256_001_1	15	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2256	001	1	1	01	01	H2256_001_1	15	Generic	4	010000	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2256	001	1	1	01	01	H2256_001_1	15	Preferred Brand	4	000101	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	30.00	60.00	90.00																			30.00	60.00	60.00																30.00				30.00		1.00			1.00			0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2256	001	1	1	01	01	H2256_001_1	15	Non-Preferred Drug	4	100100	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	80.00	160.00	240.00																			80.00	160.00	240.00																80.00				80.00		2.67			2.67			2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2256	001	1	1	01	01	H2256_001_1	15	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2256	001	2	1	01	01	H2256_001_2	15	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2256	001	2	1	01	01	H2256_001_2	15	Preferred Generic	4	001000	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2256	001	2	1	01	01	H2256_001_2	15	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2256	001	2	1	01	01	H2256_001_2	15	Generic	4	010000	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2256	001	2	1	01	01	H2256_001_2	15	Preferred Brand	4	000101	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	30.00	60.00	90.00																			30.00	60.00	60.00																30.00				30.00		1.00			1.00			0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2256	001	2	1	01	01	H2256_001_2	15	Non-Preferred Drug	4	100100	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	80.00	160.00	240.00																			80.00	160.00	240.00																80.00				80.00		2.67			2.67			2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2256	001	2	1	01	01	H2256_001_2	15	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2256	001	6	1	01	01	H2256_001_6	15	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2256	001	6	1	01	01	H2256_001_6	15	Preferred Generic	4	001000	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2256	001	6	1	01	01	H2256_001_6	15	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2256	001	6	1	01	01	H2256_001_6	15	Generic	4	010000	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2256	001	6	1	01	01	H2256_001_6	15	Preferred Brand	4	000101	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	30.00	60.00	90.00																			30.00	60.00	60.00																30.00				30.00		1.00			1.00			0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2256	001	6	1	01	01	H2256_001_6	15	Non-Preferred Drug	4	100100	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	80.00	160.00	240.00																			80.00	160.00	240.00																80.00				80.00		2.67			2.67			2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2256	001	6	1	01	01	H2256_001_6	15	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2256	015	1	1	01	01	H2256_015_1	15	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2256	015	1	1	01	01	H2256_015_1	15	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	8.00	16.00	24.00																			8.00	16.00	16.00																8.00				8.00		0.27			0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2256	015	1	1	01	01	H2256_015_1	15	Preferred Brand	4	000101	1	2	3	1	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												
H2256	015	1	1	01	01	H2256_015_1	15	Non-Preferred Drug	4	100100	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2256	015	1	1	01	01	H2256_015_1	15	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2256	015	2	1	01	01	H2256_015_2	15	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2256	015	2	1	01	01	H2256_015_2	15	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	8.00	16.00	24.00																			8.00	16.00	16.00																8.00				8.00		0.27			0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2256	015	2	1	01	01	H2256_015_2	15	Preferred Brand	4	000101	1	2	3	1	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												
H2256	015	2	1	01	01	H2256_015_2	15	Non-Preferred Drug	4	100100	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2256	015	2	1	01	01	H2256_015_2	15	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2256	015	6	1	01	01	H2256_015_6	15	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2256	015	6	1	01	01	H2256_015_6	15	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	8.00	16.00	24.00																			8.00	16.00	16.00																8.00				8.00		0.27			0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2256	015	6	1	01	01	H2256_015_6	15	Preferred Brand	4	000101	1	2	3	1	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												
H2256	015	6	1	01	01	H2256_015_6	15	Non-Preferred Drug	4	100100	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2256	015	6	1	01	01	H2256_015_6	15	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2256	018	1	1	01	01	H2256_018_1	15	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2256	018	1	1	01	01	H2256_018_1	15	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	8.00	16.00	24.00																			8.00	16.00	16.00																8.00				8.00		0.27			0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2256	018	1	1	01	01	H2256_018_1	15	Preferred Brand	4	000101	1	2	3	1	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												
H2256	018	1	1	01	01	H2256_018_1	15	Non-Preferred Drug	4	100100	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2256	018	1	1	01	01	H2256_018_1	15	Specialty Tier	4	010010	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												
H2256	018	7	1	01	01	H2256_018_7	15	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2256	018	7	1	01	01	H2256_018_7	15	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	8.00	16.00	24.00																			8.00	16.00	16.00																8.00				8.00		0.27			0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2256	018	7	1	01	01	H2256_018_7	15	Preferred Brand	4	000101	1	2	3	1	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												
H2256	018	7	1	01	01	H2256_018_7	15	Non-Preferred Drug	4	100100	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2256	018	7	1	01	01	H2256_018_7	15	Specialty Tier	4	010010	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												
H2256	018	8	1	01	01	H2256_018_8	15	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2256	018	8	1	01	01	H2256_018_8	15	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	8.00	16.00	24.00																			8.00	16.00	16.00																8.00				8.00		0.27			0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2256	018	8	1	01	01	H2256_018_8	15	Preferred Brand	4	000101	1	2	3	1	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												
H2256	018	8	1	01	01	H2256_018_8	15	Non-Preferred Drug	4	100100	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2256	018	8	1	01	01	H2256_018_8	15	Specialty Tier	4	010010	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												
H2256	026	1	1	01	01	H2256_026_1	15	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2256	026	1	1	01	01	H2256_026_1	15	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	8.00	16.00	24.00																			8.00	16.00	16.00																8.00				8.00		0.27			0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2256	026	1	1	01	01	H2256_026_1	15	Preferred Brand	4	000101	1	2	3	1	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												
H2256	026	1	1	01	01	H2256_026_1	15	Non-Preferred Drug	4	100100	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2256	026	1	1	01	01	H2256_026_1	15	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31					27																				27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2256	026	2	1	01	01	H2256_026_2	15	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2256	026	2	1	01	01	H2256_026_2	15	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	8.00	16.00	24.00																			8.00	16.00	16.00																8.00				8.00		0.27			0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2256	026	2	1	01	01	H2256_026_2	15	Preferred Brand	4	000101	1	2	3	1	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												
H2256	026	2	1	01	01	H2256_026_2	15	Non-Preferred Drug	4	100100	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2256	026	2	1	01	01	H2256_026_2	15	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31					27																				27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2256	026	3	1	01	01	H2256_026_3	15	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2256	026	3	1	01	01	H2256_026_3	15	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	8.00	16.00	24.00																			8.00	16.00	16.00																8.00				8.00		0.27			0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2256	026	3	1	01	01	H2256_026_3	15	Preferred Brand	4	000101	1	2	3	1	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												
H2256	026	3	1	01	01	H2256_026_3	15	Non-Preferred Drug	4	100100	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2256	026	3	1	01	01	H2256_026_3	15	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31					27																				27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2256	028	0	1	01	01	H2256_028_0	15	Preferred Generic	4	001000	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	12.00																6.00				6.00		0.20			0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2256	028	0	1	01	01	H2256_028_0	15	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	12.00	24.00	36.00																			12.00	24.00	24.00																12.00				12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2256	028	0	1	01	01	H2256_028_0	15	Preferred Brand	4	000101	1	2	3	1	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												
H2256	028	0	1	01	01	H2256_028_0	15	Non-Preferred Drug	4	100100	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2256	028	0	1	01	01	H2256_028_0	15	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31					26																				26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2256	033	0	1	01	01	H2256_033_0	15	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2256	033	0	1	01	01	H2256_033_0	15	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	6.00	12.00	18.00																			6.00	12.00	12.00																6.00				6.00		0.20			0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2256	033	0	1	01	01	H2256_033_0	15	Preferred Brand	4	000101	1	2	3	1	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												
H2256	033	0	1	01	01	H2256_033_0	15	Non-Preferred Drug	4	100100	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				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												
H2256	033	0	1	01	01	H2256_033_0	15	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2256	034	0	1	01	01	H2256_034_0	15	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2256	034	0	1	01	01	H2256_034_0	15	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	6.00	12.00	18.00																			6.00	12.00	12.00																6.00				6.00		0.20			0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2256	034	0	1	01	01	H2256_034_0	15	Preferred Brand	4	000101	1	2	3	1	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												
H2256	034	0	1	01	01	H2256_034_0	15	Non-Preferred Drug	4	100100	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				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												
H2256	034	0	1	01	01	H2256_034_0	15	Specialty Tier	4	010010	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												
H2256	036	0	1	01	01	H2256_036_0	15	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2256	036	0	1	01	01	H2256_036_0	15	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	6.00	12.00	18.00																			6.00	12.00	12.00																6.00				6.00		0.20			0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2256	036	0	1	01	01	H2256_036_0	15	Preferred Brand	4	000101	1	2	3	1	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												
H2256	036	0	1	01	01	H2256_036_0	15	Non-Preferred Drug	4	100100	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				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												
H2256	036	0	1	01	01	H2256_036_0	15	Specialty Tier	4	010010	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												
H2261	005	0	1	01	01	H2261_005_0	8	Preferred Generic	4	001000	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	2.00	2.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2261	005	0	1	01	01	H2261_005_0	8	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	6.00	12.00	18.00																			6.00	12.00	12.00																6.00				6.00		0.20			0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2261	005	0	1	01	01	H2261_005_0	8	Preferred Brand	4	000001	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2261	005	0	1	01	01	H2261_005_0	8	Non-Preferred Brand	4	100000	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 Brand, Specialty Tier												
H2261	005	0	1	01	01	H2261_005_0	8	Specialty Tier	4	010010	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 Brand, Specialty Tier												
H2261	019	0	1	01	01	H2261_019_0	7	Preferred Generic	4	001000	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 Brand, Specialty Tier												
H2261	019	0	1	01	01	H2261_019_0	7	Generic	4	010000	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 Brand, Specialty Tier												
H2261	019	0	1	01	01	H2261_019_0	7	Preferred Brand	4	000001	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2261	019	0	1	01	01	H2261_019_0	7	Non-Preferred Brand	4	100000	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 Brand, Specialty Tier												
H2261	019	0	1	01	01	H2261_019_0	7	Specialty Tier	4	010010	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 Brand, Specialty Tier												
H2261	021	0	1	02	01	H2261_021_0	11	Preferred Generic	4	001000	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	2.00	2.00																2.00				2.00		.07			.07			.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2261	021	0	1	02	01	H2261_021_0	11	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	6.00	12.00	18.00																			6.00	12.00	12.00																6.00				6.00		.20			.20			.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2261	021	0	1	02	01	H2261_021_0	11	Preferred Brand	4	000001	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2261	021	0	1	02	01	H2261_021_0	11	Non-Preferred Brand	4	100000	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 Brand, Specialty Tier												
H2261	021	0	1	02	01	H2261_021_0	11	Specialty Tier	4	010010	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 Brand, Specialty Tier												
H2320	007	0	1	02	01	H2320_007_0	11	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	0.00																6.00				6.00			0.20	0.03	0.03			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	007	0	1	02	01	H2320_007_0	11	Generic	4	010010	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								13.00	26.00	39.00					8.00	16.00	24.00					8.00	16.00	0.00																13.00				13.00			0.43	0.27	0.27			0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	007	0	1	02	01	H2320_007_0	11	Preferred Brand	4	000001	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								43.00	86.00	129.00					38.00	76.00	114.00					38.00	76.00	95.00																43.00				43.00			1.43	1.27	1.27			1.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	007	0	1	02	01	H2320_007_0	11	Non-Preferred Drug	4	110000	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								88.00	176.00	264.00					83.00	166.00	249.00					83.00	166.00	207.50																88.00				88.00			2.93	2.77	2.77			2.84	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	007	0	1	02	01	H2320_007_0	11	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	008	0	1	02	01	H2320_008_0	11	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	0.00																6.00				6.00			0.20	0.03	0.03			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	008	0	1	02	01	H2320_008_0	11	Generic	4	010010	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								13.00	26.00	39.00					8.00	16.00	24.00					8.00	16.00	0.00																13.00				13.00			0.43	0.27	0.27			0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	008	0	1	02	01	H2320_008_0	11	Preferred Brand	4	000001	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								43.00	86.00	129.00					38.00	76.00	114.00					38.00	76.00	95.00																43.00				43.00			1.43	1.27	1.27			1.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	008	0	1	02	01	H2320_008_0	11	Non-Preferred Drug	4	110000	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								88.00	176.00	264.00					83.00	166.00	249.00					83.00	166.00	207.50																88.00				88.00			2.93	2.77	2.77			2.84	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	008	0	1	02	01	H2320_008_0	11	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	011	0	1	02	01	H2320_011_0	9	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	0.00																7.00				7.00			0.23	0.07	0.07			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	011	0	1	02	01	H2320_011_0	9	Generic	4	010010	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					10.00	20.00	30.00					10.00	20.00	0.00																15.00				15.00			0.50	0.33	0.33			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	011	0	1	02	01	H2320_011_0	9	Preferred Brand	4	000001	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	105.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	011	0	1	02	01	H2320_011_0	9	Non-Preferred Drug	4	110000	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												
H2320	011	0	1	02	01	H2320_011_0	9	Specialty Tier	4	010010	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												
H2320	012	0	1	02	01	H2320_012_0	9	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	0.00																7.00				7.00			0.23	0.07	0.07			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	012	0	1	02	01	H2320_012_0	9	Generic	4	010010	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					10.00	20.00	30.00					10.00	20.00	0.00																15.00				15.00			0.50	0.33	0.33			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	012	0	1	02	01	H2320_012_0	9	Preferred Brand	4	000001	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	105.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	012	0	1	02	01	H2320_012_0	9	Non-Preferred Drug	4	110000	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												
H2320	012	0	1	02	01	H2320_012_0	9	Specialty Tier	4	010010	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												
H2320	013	0	1	02	01	H2320_013_0	11	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	0.00																6.00				6.00			0.20	0.03	0.03			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	013	0	1	02	01	H2320_013_0	11	Generic	4	010010	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								13.00	26.00	39.00					8.00	16.00	24.00					8.00	16.00	0.00																13.00				13.00			0.43	0.27	0.27			0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	013	0	1	02	01	H2320_013_0	11	Preferred Brand	4	000001	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								43.00	86.00	129.00					38.00	76.00	114.00					38.00	76.00	95.00																43.00				43.00			1.43	1.27	1.27			1.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	013	0	1	02	01	H2320_013_0	11	Non-Preferred Drug	4	110000	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								88.00	176.00	264.00					83.00	166.00	249.00					83.00	166.00	207.50																88.00				88.00			2.93	2.77	2.77			2.84	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	013	0	1	02	01	H2320_013_0	11	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	015	0	1	02	01	H2320_015_0	9	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	0.00																7.00				7.00			0.23	0.07	0.07			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	015	0	1	02	01	H2320_015_0	9	Generic	4	010010	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					10.00	20.00	30.00					10.00	20.00	0.00																15.00				15.00			0.50	0.33	0.33			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	015	0	1	02	01	H2320_015_0	9	Preferred Brand	4	000001	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	105.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	015	0	1	02	01	H2320_015_0	9	Non-Preferred Drug	4	110000	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												
H2320	015	0	1	02	01	H2320_015_0	9	Specialty Tier	4	010010	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												
H2320	016	0	1	02	01	H2320_016_0	11	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	0.00																6.00				6.00			0.20	0.03	0.03			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	016	0	1	02	01	H2320_016_0	11	Generic	4	010010	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								13.00	26.00	39.00					8.00	16.00	24.00					8.00	16.00	0.00																13.00				13.00			0.43	0.27	0.27			0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	016	0	1	02	01	H2320_016_0	11	Preferred Brand	4	000001	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								43.00	86.00	129.00					38.00	76.00	114.00					38.00	76.00	95.00																43.00				43.00			1.43	1.27	1.27			1.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	016	0	1	02	01	H2320_016_0	11	Non-Preferred Drug	4	110000	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								88.00	176.00	264.00					83.00	166.00	249.00					83.00	166.00	207.50																88.00				88.00			2.93	2.77	2.77			2.84	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	016	0	1	02	01	H2320_016_0	11	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	018	0	1	02	01	H2320_018_0	9	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	0.00																7.00				7.00			0.23	0.07	0.07			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	018	0	1	02	01	H2320_018_0	9	Generic	4	010010	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					10.00	20.00	30.00					10.00	20.00	0.00																15.00				15.00			0.50	0.33	0.33			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	018	0	1	02	01	H2320_018_0	9	Preferred Brand	4	000001	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	105.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	018	0	1	02	01	H2320_018_0	9	Non-Preferred Drug	4	110000	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												
H2320	018	0	1	02	01	H2320_018_0	9	Specialty Tier	4	010010	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												
H2320	019	0	1	02	01	H2320_019_0	11	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	0.00																6.00				6.00			0.20	0.03	0.03			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	019	0	1	02	01	H2320_019_0	11	Generic	4	010010	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								13.00	26.00	39.00					8.00	16.00	24.00					8.00	16.00	0.00																13.00				13.00			0.43	0.27	0.27			0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	019	0	1	02	01	H2320_019_0	11	Preferred Brand	4	000001	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								43.00	86.00	129.00					38.00	76.00	114.00					38.00	76.00	95.00																43.00				43.00			1.43	1.27	1.27			1.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	019	0	1	02	01	H2320_019_0	11	Non-Preferred Drug	4	110000	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								88.00	176.00	264.00					83.00	166.00	249.00					83.00	166.00	207.50																88.00				88.00			2.93	2.77	2.77			2.84	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	019	0	1	02	01	H2320_019_0	11	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	021	0	1	02	01	H2320_021_0	9	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	0.00																7.00				7.00			0.23	0.07	0.07			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	021	0	1	02	01	H2320_021_0	9	Generic	4	010010	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					10.00	20.00	30.00					10.00	20.00	0.00																15.00				15.00			0.50	0.33	0.33			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	021	0	1	02	01	H2320_021_0	9	Preferred Brand	4	000001	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	105.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2320	021	0	1	02	01	H2320_021_0	9	Non-Preferred Drug	4	110000	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												
H2320	021	0	1	02	01	H2320_021_0	9	Specialty Tier	4	010010	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												
H2322	004	0	1	04	01	H2322_004_0	4	Preferred Generic	4	001000	3	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, Specialty Tier												
H2322	004	0	1	04	01	H2322_004_0	4	Preferred Generic	4	001000	3	2	1	3	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, Specialty Tier										1		3
H2322	004	0	1	04	01	H2322_004_0	4	Generic	4	010000	3	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, Specialty Tier												
H2322	004	0	1	04	01	H2322_004_0	4	Generic	4	010000	3	2	2	3	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, Specialty Tier										1		3
H2322	004	0	1	04	01	H2322_004_0	4	Preferred Brand	4	000001	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	40.00	80.00	100.00																			40.00	80.00	100.00																40.00				40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2322	004	0	1	04	01	H2322_004_0	4	Non-Preferred Brand	4	100000	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, Specialty Tier												
H2322	004	0	1	04	01	H2322_004_0	4	Specialty Tier	4	000010	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 Brand, Specialty Tier												
H2322	008	0	1	04	01	H2322_008_0	4	Preferred Generic	4	001000	3	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	5.00																			2.00	4.00	5.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2322	008	0	1	04	01	H2322_008_0	4	Generic	4	010000	3	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	37.50																			15.00	30.00	37.50																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2322	008	0	1	04	01	H2322_008_0	4	Preferred Brand	4	000001	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	112.50																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2322	008	0	1	04	01	H2322_008_0	4	Non-Preferred Brand	4	100000	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, Specialty Tier												
H2322	008	0	1	04	01	H2322_008_0	4	Specialty Tier	4	000010	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 Brand, Specialty Tier												
H2334	001	0	1	04	01	H2334_001_0	10	Preferred Generic	4	001000	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	4.00	8.00	12.00																					8.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2334	001	0	1	04	01	H2334_001_0	10	Generic	4	010000	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	12.00	24.00	36.00																					24.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2334	001	0	1	04	01	H2334_001_0	10	Preferred Brand	4	000001	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					94.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2334	001	0	1	04	01	H2334_001_0	10	Non-Preferred Drug	4	100100	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					200.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2334	001	0	1	04	01	H2334_001_0	10	Specialty Tier	4	010010	1	1	5	1	111		01	100		1	30	60	90				1	2			90				30		31					28	28	28																				28															28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2334	001	0	1	04	01	H2334_001_0	10	Select Care Drugs	4	010010	1	2	6	1	111		01	100		1	30	60	90				1	2			90				30		31	11.00	22.00	33.00																					22.00																11.00				11.00		0.37						0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2334	002	0	1	04	01	H2334_002_0	10	Preferred Generic	4	001000	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, Select Care Drugs												
H2334	002	0	1	04	01	H2334_002_0	10	Generic	4	010000	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	12.00	24.00	36.00																					24.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2334	002	0	1	04	01	H2334_002_0	10	Preferred Brand	4	000001	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					94.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2334	002	0	1	04	01	H2334_002_0	10	Non-Preferred Drug	4	100100	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					200.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2334	002	0	1	04	01	H2334_002_0	10	Specialty Tier	4	010010	1	1	5	1	111		01	100		1	30	60	90				1	2			90				30		31					28	28	28																				28															28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2334	002	0	1	04	01	H2334_002_0	10	Select Care Drugs	4	010010	1	2	6	1	111		01	100		1	30	60	90				1	2			90				30		31	11.00	22.00	33.00																					22.00																11.00				11.00		0.37						0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2334	003	0	1	04	01	H2334_003_0	9	Preferred Generic	4	001000	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	4.00	8.00	12.00																					8.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2334	003	0	1	04	01	H2334_003_0	9	Generic	4	010000	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	12.00	24.00	36.00																					24.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2334	003	0	1	04	01	H2334_003_0	9	Preferred Brand	4	000001	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												
H2334	003	0	1	04	01	H2334_003_0	9	Non-Preferred Brand	4	100100	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												
H2334	003	0	1	04	01	H2334_003_0	9	Specialty Tier	4	010010	1	1	5	1	111		01	100		1	30	60	90				1	2			90				30		31					28	28	28																				28															28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2334	004	0	1	04	01	H2334_004_0	9	Preferred Generic	4	001000	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												
H2334	004	0	1	04	01	H2334_004_0	9	Generic	4	010000	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	12.00	24.00	36.00																					24.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2334	004	0	1	04	01	H2334_004_0	9	Preferred Brand	4	000001	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												
H2334	004	0	1	04	01	H2334_004_0	9	Non-Preferred Brand	4	100100	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												
H2334	004	0	1	04	01	H2334_004_0	9	Specialty Tier	4	010010	1	1	5	1	111		01	100		1	30	60	90				1	2			90				30		31					28	28	28																				28															28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2354	015	0	1	01	01	H2354_015_0	4	Preferred Generic	4	001000	3	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	5.00																			2.00	4.00	5.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2354	015	0	1	01	01	H2354_015_0	4	Generic	4	010000	3	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	11.00	22.00	27.50																			11.00	11.00	27.50																11.00				11.00		0.37			0.37			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2354	015	0	1	01	01	H2354_015_0	4	Preferred Brand	4	000001	3	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	112.50																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2354	015	0	1	01	01	H2354_015_0	4	Non-Preferred Brand	4	100000	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	237.50																			95.00	190.00	237.50																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2354	015	0	1	01	01	H2354_015_0	4	Specialty Tier	4	000010	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 Brand, Specialty Tier												
H2354	018	0	1	01	01	H2354_018_0	5	Preferred Generic	4	001000	3	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	5.00																			2.00	4.00	5.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2354	018	0	1	01	01	H2354_018_0	5	Generic	4	010000	3	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	37.50																			15.00	30.00	37.50																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2354	018	0	1	01	01	H2354_018_0	5	Preferred Brand	4	000001	3	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	112.50																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2354	018	0	1	01	01	H2354_018_0	5	Non-Preferred Brand	4	100000	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, Specialty Tier												
H2354	018	0	1	01	01	H2354_018_0	5	Specialty Tier	4	000010	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					29	29	29																		29	29	29															29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2354	020	0	1	02	01	H2354_020_0	4	Preferred Generic	4	001000	3	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	6.00	12.00	15.00																			6.00	12.00	15.00																6.00				6.00		0.20			0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2354	020	0	1	02	01	H2354_020_0	4	Generic	4	010000	3	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	11.00	22.00	27.50																			11.00	22.00	27.50																11.00				11.00		0.37			0.37			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2354	020	0	1	02	01	H2354_020_0	4	Preferred Brand	4	000001	3	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	112.50																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2354	020	0	1	02	01	H2354_020_0	4	Non-Preferred Brand	4	100000	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, Specialty Tier												
H2354	020	0	1	02	01	H2354_020_0	4	Specialty Tier	4	000010	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 Brand, Specialty Tier												
H2354	021	0	1	02	01	H2354_021_0	4	Preferred Generic	4	001000	3	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	5.00																			2.00	4.00	5.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2354	021	0	1	02	01	H2354_021_0	4	Generic	4	010000	3	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	37.50																			15.00	30.00	37.50																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2354	021	0	1	02	01	H2354_021_0	4	Preferred Brand	4	000001	3	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	112.50																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2354	021	0	1	02	01	H2354_021_0	4	Non-Preferred Brand	4	100000	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, Specialty Tier												
H2354	021	0	1	02	01	H2354_021_0	4	Specialty Tier	4	000010	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 Brand, Specialty Tier												
H2354	022	0	1	02	01	H2354_022_0	4	Preferred Generic	4	001000	3	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, Specialty Tier												
H2354	022	0	1	02	01	H2354_022_0	4	Preferred Generic	4	001000	3	2	1	3	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, Specialty Tier										1		1
H2354	022	0	1	02	01	H2354_022_0	4	Generic	4	010000	3	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, Specialty Tier												
H2354	022	0	1	02	01	H2354_022_0	4	Generic	4	010000	3	2	2	3	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, Specialty Tier										1		1
H2354	022	0	1	02	01	H2354_022_0	4	Preferred Brand	4	000001	3	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	112.50																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2354	022	0	1	02	01	H2354_022_0	4	Non-Preferred Brand	4	100000	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, Specialty Tier												
H2354	022	0	1	02	01	H2354_022_0	4	Specialty Tier	4	000010	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					32	32	32																		32	32	32															32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2450	001	0	1	18	06	H2450_001_0	7	Preferred Generic	4	001001	1	2	1	1	110		01	100		1	31		93				1	2			93				31		31	2.00		6.00																					4.00																2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	001	0	1	18	06	H2450_001_0	7	Generic	4	010001	1	2	2	1	110		01	100		1	31		93				1	2			93				31		31	8.00		24.00																					16.00																8.00				8.00		0.26						0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	001	0	1	18	06	H2450_001_0	7	Preferred Brand	4	000101	1	2	3	1	110		01	100		1	31		93				1	2			93				31		31	35.00		105.00																					70.00																35.00				35.00		1.13						1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	001	0	1	18	06	H2450_001_0	7	Non-Preferred Drug	4	100100	1	1	4	1	110		01	100		1	31		93				1	2			93				31		31				42.09	50		50																				50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	001	0	1	18	06	H2450_001_0	7	Specialty Tier	4	010010	1	1	5	1	110		01	100		1	31		93				1	2			93				31		31					33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	002	0	1	18	06	H2450_002_0	7	Preferred Generic	4	001001	1	2	1	1	110		01	100		1	31		93				1	2			93				31		31	2.00		6.00																					4.00																2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	002	0	1	18	06	H2450_002_0	7	Generic	4	010001	1	2	2	1	110		01	100		1	31		93				1	2			93				31		31	8.00		24.00																					16.00																8.00				8.00		0.26						0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	002	0	1	18	06	H2450_002_0	7	Preferred Brand	4	000101	1	2	3	1	110		01	100		1	31		93				1	2			93				31		31	35.00		105.00																					70.00																35.00				35.00		1.13						1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	002	0	1	18	06	H2450_002_0	7	Non-Preferred Drug	4	100100	1	1	4	1	110		01	100		1	31		93				1	2			93				31		31				34.92	50		50																				50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	002	0	1	18	06	H2450_002_0	7	Specialty Tier	4	010010	1	1	5	1	110		01	100		1	31		93				1	2			93				31		31					33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	007	0	1	18	06	H2450_007_0	7	Preferred Generic	3	001001	1	2	1	1	110		01	100		1	31		93				1	2			93				31		31	2.00		6.00																					4.00																2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	007	0	1	18	06	H2450_007_0	7	Generic	3	010001	1	2	2	1	110		01	100		1	31		93				1	2			93				31		31	10.00		30.00																					20.00																10.00				10.00		0.32						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	007	0	1	18	06	H2450_007_0	7	Preferred Brand	3	000101	1	2	3	1	110		01	100		1	31		93				1	2			93				31		31	34.00		102.00																					68.00																34.00				34.00		1.10						1.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	007	0	1	18	06	H2450_007_0	7	Non-Preferred Drug	3	100100	1	1	4	1	110		01	100		1	31		93				1	2			93				31		31				52.85	50		50																				50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	007	0	1	18	06	H2450_007_0	7	Specialty Tier	3	010010	1	1	5	1	110		01	100		1	31		93				1	2			93				31		31					29		29																				29															29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	016	0	1	18	06	H2450_016_0	7	Preferred Generic	3	001001	1	2	1	1	110		01	100		1	31		93				1	2			93				31		31	3.00		9.00																					6.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	016	0	1	18	06	H2450_016_0	7	Generic	3	010001	1	2	2	1	110		01	100		1	31		93				1	2			93				31		31	10.00		30.00																					20.00																10.00				10.00		0.32						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	016	0	1	18	06	H2450_016_0	7	Preferred Brand	3	000101	1	2	3	1	110		01	100		1	31		93				1	2			93				31		31	25.00		75.00																					50.00																25.00				25.00		0.81						0.81	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	016	0	1	18	06	H2450_016_0	7	Non-Preferred Drug	3	100100	1	1	4	1	110		01	100		1	31		93				1	2			93				31		31				41.17	50		50																				50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	016	0	1	18	06	H2450_016_0	7	Specialty Tier	3	010010	1	1	5	1	110		01	100		1	31		93				1	2			93				31		31					28		28																				28															28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	017	0	1	18	06	H2450_017_0	7	Preferred Generic	3	001001	1	2	1	1	110		01	100		1	31		93				1	2			93				31		31	3.00		9.00																					6.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	017	0	1	18	06	H2450_017_0	7	Generic	3	010001	1	2	2	1	110		01	100		1	31		93				1	2			93				31		31	13.00		39.00																					26.00																13.00				13.00		0.42						0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	017	0	1	18	06	H2450_017_0	7	Preferred Brand	3	000101	1	2	3	1	110		01	100		1	31		93				1	2			93				31		31	27.00		81.00																					54.00																27.00				27.00		0.87						0.87	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	017	0	1	18	06	H2450_017_0	7	Non-Preferred Drug	3	100100	1	1	4	1	110		01	100		1	31		93				1	2			93				31		31				38.56	50		50																				50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	017	0	1	18	06	H2450_017_0	7	Specialty Tier	3	010010	1	1	5	1	110		01	100		1	31		93				1	2			93				31		31					28		28																				28															28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	022	0	1	18	06	H2450_022_0	7	Preferred Generic	3	001001	1	2	1	1	110		01	100		1	31		93				1	2			93				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												
H2450	022	0	1	18	06	H2450_022_0	7	Generic	3	010001	1	2	2	1	110		01	100		1	31		93				1	2			93				31		31	10.00		30.00																					20.00																10.00				10.00		0.32						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	022	0	1	18	06	H2450_022_0	7	Preferred Brand	3	000101	1	2	3	1	110		01	100		1	31		93				1	2			93				31		31	45.00		135.00																					90.00																45.00				45.00		1.45						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	022	0	1	18	06	H2450_022_0	7	Non-Preferred Drug	3	100100	1	1	4	1	110		01	100		1	31		93				1	2			93				31		31				55.19	50		50																				50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	022	0	1	18	06	H2450_022_0	7	Specialty Tier	3	010010	1	1	5	1	110		01	100		1	31		93				1	2			93				31		31					26		26																				26															26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	023	0	1	18	06	H2450_023_0	7	Preferred Generic	4	001001	1	2	1	1	110		01	100		1	31		93				1	2			93				31		31	2.00		6.00																					4.00																2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	023	0	1	18	06	H2450_023_0	7	Generic	4	010001	1	2	2	1	110		01	100		1	31		93				1	2			93				31		31	8.00		24.00																					16.00																8.00				8.00		0.26						0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	023	0	1	18	06	H2450_023_0	7	Preferred Brand	4	000101	1	2	3	1	110		01	100		1	31		93				1	2			93				31		31	35.00		105.00																					70.00																35.00				35.00		1.13						1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	023	0	1	18	06	H2450_023_0	7	Non-Preferred Drug	4	100100	1	1	4	1	110		01	100		1	31		93				1	2			93				31		31				52.18	50		50																				50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	023	0	1	18	06	H2450_023_0	7	Specialty Tier	4	010010	1	1	5	1	110		01	100		1	31		93				1	2			93				31		31					33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	029	0	1	18	06	H2450_029_0	7	Preferred Generic	3	001001	1	2	1	1	110		01	100		1	31		93				1	2			93				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												
H2450	029	0	1	18	06	H2450_029_0	7	Generic	3	010001	1	2	2	1	110		01	100		1	31		93				1	2			93				31		31	12.00		36.00																					24.00																12.00				12.00		0.39						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	029	0	1	18	06	H2450_029_0	7	Preferred Brand	3	000101	1	2	3	1	110		01	100		1	31		93				1	2			93				31		31	25.00		75.00																					50.00																25.00				25.00		0.81						0.81	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	029	0	1	18	06	H2450_029_0	7	Non-Preferred Drug	3	100100	1	1	4	1	110		01	100		1	31		93				1	2			93				31		31				38.88	50		50																				50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2450	029	0	1	18	06	H2450_029_0	7	Specialty Tier	3	010010	1	1	5	1	110		01	100		1	31		93				1	2			93				31		31					28		28																				28															28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	002	0	1	02	01	H2459_002_0	8	Preferred Generic	4	001000	1	2	1	1	110		10	110		1	30		90				1	2	30		90					29	31	5.00		15.00																			5.00		10.00																	5.00			5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	002	0	1	02	01	H2459_002_0	8	Preferred Generic	4	001000	1	2	1	3	110		10	110		1	30		90				1	2	30		90					29	31	5.00		15.00																			5.00		10.00																	5.00			5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2459	002	0	1	02	01	H2459_002_0	8	Generic	4	010000	1	2	2	1	110		10	110		1	30		90				1	2	30		90					29	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												
H2459	002	0	1	02	01	H2459_002_0	8	Generic	4	010000	1	2	2	3	110		10	110		1	30		90				1	2	30		90					29	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										1		
H2459	002	0	1	02	01	H2459_002_0	8	Preferred Brand	4	000001	1	2	3	1	110		10	110		1	30		90				1	2	30		90					29	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												
H2459	002	0	1	02	01	H2459_002_0	8	Non-Preferred Drug	4	100100	1	2	4	1	110		10	110		1	30		90				1	2	30		90					29	31	80.00		240.00																			80.00		160.00																	80.00			80.00		2.67			2.67			2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	002	0	1	02	01	H2459_002_0	8	Specialty Tier	4	010010	1	1	5	1	110		10	110		1	30		90				1	2	30		90					29	31				855.78	31		31																		31		31																31		31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	013	0	1	02	01	H2459_013_0	11	Preferred Generic	4	001000	1	2	1	1	110		10	110		1	30		90				1	2	30		90					29	31	6.00		18.00																			6.00		12.00																	6.00			6.00		0.20			0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	013	0	1	02	01	H2459_013_0	11	Generic	4	010000	1	2	2	1	110		10	110		1	30		90				1	2	30		90					29	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												
H2459	013	0	1	02	01	H2459_013_0	11	Preferred Brand	4	000001	1	2	3	1	110		10	110		1	30		90				1	2	30		90					29	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												
H2459	013	0	1	02	01	H2459_013_0	11	Non-Preferred Drug	4	100100	1	2	4	1	110		10	110		1	30		90				1	2	30		90					29	31	80.00		240.00																			80.00		160.00																	80.00			80.00		2.67			2.67			2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	013	0	1	02	01	H2459_013_0	11	Specialty Tier	4	010010	1	1	5	1	110		10	110		1	30		90				1	2	30		90					29	31				823.07	30		30																		30		30																30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	019	0	1	02	01	H2459_019_0	9	Preferred Generic	4	001000	1	2	1	1	110		10	110		1	30		90				1	2	30		90					29	31	6.00		18.00																			6.00		12.00																	6.00			6.00		0.20			0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	019	0	1	02	01	H2459_019_0	9	Generic	4	010000	1	2	2	1	110		10	110		1	30		90				1	2	30		90					29	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												
H2459	019	0	1	02	01	H2459_019_0	9	Preferred Brand	4	000001	1	2	3	1	110		10	110		1	30		90				1	2	30		90					29	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												
H2459	019	0	1	02	01	H2459_019_0	9	Non-Preferred Drug	4	100100	1	2	4	1	110		10	110		1	30		90				1	2	30		90					29	31	90.00		270.00																			90.00		180.00																	90.00			90.00		3.00			3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2459	019	0	1	02	01	H2459_019_0	9	Specialty Tier	4	010010	1	1	5	1	110		10	110		1	30		90				1	2	30		90					29	31				556.56	29		29																		29		29																29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2461	008	0	1	18	06	H2461_008_0	6	Preferred Generic	2	001000	1	2	1	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31								12.00	24.00	24.00					7.00	14.00	14.00					7.00	0.00	0.00																12.00				12.00			0.39	0.23	0.23			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2461	008	0	1	18	06	H2461_008_0	6	Generic	2	010000	1	2	2	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31								17.00	34.00	34.00					12.00	24.00	24.00					12.00	24.00	24.00																17.00				17.00			0.55	0.39	0.39			0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2461	008	0	1	18	06	H2461_008_0	6	Preferred Brand	2	010001	1	1	3	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31											57.40	20	20	20				43.10	15	15	15				15	15	15															20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2461	008	0	1	18	06	H2461_008_0	6	Non-Preferred Brand	2	110000	1	1	4	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31											56.89	50	50	50				51.12	45	45	45				45	45	45															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2461	008	0	1	18	06	H2461_008_0	6	Specialty Tier	2	010010	1	1	5	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31												25	25	25					25	25	25				25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2461	008	0	1	18	06	H2461_008_0	6	Select Care Drugs	2	010000	1	2	6	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31								5.00	10.00	10.00					0.00	0.00	0.00					7.00	0.00	0.00																5.00				5.00			0.16	0.00	0.23			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2461	009	0	1	18	06	H2461_009_0	6	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31								11.00	22.00	22.00					6.00	12.00	12.00					6.00	0.00	0.00																11.00				11.00			0.35	0.19	0.19			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2461	009	0	1	18	06	H2461_009_0	6	Generic	4	010000	1	2	2	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31								17.00	34.00	34.00					12.00	24.00	24.00					12.00	24.00	24.00																17.00				17.00			0.55	0.39	0.39			0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2461	009	0	1	18	06	H2461_009_0	6	Preferred Brand	4	010001	1	1	3	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31											73.56	25	25	25				58.91	20	20	20				20	20	20															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2461	009	0	1	18	06	H2461_009_0	6	Non-Preferred Brand	4	110000	1	1	4	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31											77.36	50	50	50				69.55	45	45	45				45	45	45															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2461	009	0	1	18	06	H2461_009_0	6	Specialty Tier	4	010010	1	1	5	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31												25	25	25					25	25	25				25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2461	009	0	1	18	06	H2461_009_0	6	Select Care Drugs	4	010000	1	2	6	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31								5.00	10.00	10.00					0.00	0.00	0.00					6.00	0.00	0.00																5.00				5.00			0.16	0.00	0.19			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2461	010	0	1	18	06	H2461_010_0	6	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31								8.00	16.00	16.00					3.00	6.00	6.00					3.00	0.00	0.00																8.00				8.00			0.26	0.10	0.10			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2461	010	0	1	18	06	H2461_010_0	6	Generic	4	010000	1	2	2	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31								12.00	24.00	24.00					7.00	14.00	14.00					7.00	14.00	14.00																12.00				12.00			0.39	0.23	0.23			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2461	010	0	1	18	06	H2461_010_0	6	Preferred Brand	4	010001	1	1	3	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31											58.01	20	20	20				43.56	15	15	15				15	15	15															20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2461	010	0	1	18	06	H2461_010_0	6	Non-Preferred Brand	4	110000	1	1	4	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31											68.56	50	50	50				61.61	45	45	45				45	45	45															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2461	010	0	1	18	06	H2461_010_0	6	Specialty Tier	4	010010	1	1	5	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31												25	25	25					25	25	25				25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2461	010	0	1	18	06	H2461_010_0	6	Select Care Drugs	4	010000	1	2	6	1		111	01	111		1				31	60	90	1	2	31	60	90				31		31								5.00	10.00	10.00					0.00	0.00	0.00					3.00	0.00	0.00																5.00				5.00			0.16	0.00	0.10			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2462	008	0	1	18	06	H2462_008_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		12.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2462	008	0	1	18	06	H2462_008_0	4	Generic	4	010000	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	19.00		57.00																									19.00		57.00				19.00		38.00				19.00				19.00		0.63				0.63	0.63	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2462	008	0	1	18	06	H2462_008_0	4	Preferred Brand	4	000001	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2462	008	0	1	18	06	H2462_008_0	4	Non-Preferred Brand	4	100000	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2462	008	0	1	18	06	H2462_008_0	4	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				1376.41	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2462	011	0	1	18	06	H2462_011_0	6	Preferred Generic	3	001000	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		14.00				7.00				7.00		0.23				0.23	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2462	011	0	1	18	06	H2462_011_0	6	Generic	3	010000	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	16.00		48.00																									16.00		48.00				16.00		32.00				16.00				16.00		0.53				0.53	0.53	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2462	011	0	1	18	06	H2462_011_0	6	Preferred Brand	3	000001	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2462	011	0	1	18	06	H2462_011_0	6	Non-Preferred Brand	3	100000	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2462	011	0	1	18	06	H2462_011_0	6	Specialty Tier	3	010010	1	1	5	1	010		01		010	1	30											30			30		31				1468.11	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2462	012	0	1	18	06	H2462_012_0	5	Preferred Generic	4	001000	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		14.00				7.00				7.00		0.23				0.23	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2462	012	0	1	18	06	H2462_012_0	5	Preferred Generic	4	001000	1	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		14.00				7.00				7.00		0.23				0.23	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2462	012	0	1	18	06	H2462_012_0	5	Generic	4	010000	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		30.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2462	012	0	1	18	06	H2462_012_0	5	Generic	4	010000	1	2	2	3	110		01		110	1	30		90				1	2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		30.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2462	012	0	1	18	06	H2462_012_0	5	Preferred Brand	4	000001	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	40.00		120.00																									40.00		120.00				40.00		80.00				40.00				40.00		1.33				1.33	1.33	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2462	012	0	1	18	06	H2462_012_0	5	Preferred Brand	4	000001	1	1	3	3	110		01		110	1	30		90				1	2				30		90	30		31				1646.23	50		50																								55		55				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2462	012	0	1	18	06	H2462_012_0	5	Non-Preferred Brand	4	100000	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	85.00		255.00																									85.00		255.00				85.00		170.00				85.00				85.00		2.83				2.83	2.83	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2462	012	0	1	18	06	H2462_012_0	5	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				1646.23	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2462	019	0	1	18	06	H2462_019_0	4	Preferred Generic	3	001000	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		12.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2462	019	0	1	18	06	H2462_019_0	4	Generic	3	010000	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		40.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2462	019	0	1	18	06	H2462_019_0	4	Preferred Brand	3	000001	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2462	019	0	1	18	06	H2462_019_0	4	Non-Preferred Brand	3	100000	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2462	019	0	1	18	06	H2462_019_0	4	Specialty Tier	3	010010	1	1	5	1	010		01		010	1	30											30			30		31				1426.81	28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2462	021	0	1	18	06	H2462_021_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		12.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2462	021	0	1	18	06	H2462_021_0	4	Generic	4	010000	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	19.00		57.00																									19.00		57.00				19.00		38.00				19.00				19.00		0.63				0.63	0.63	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2462	021	0	1	18	06	H2462_021_0	4	Preferred Brand	4	000001	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2462	021	0	1	18	06	H2462_021_0	4	Non-Preferred Brand	4	100000	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2462	021	0	1	18	06	H2462_021_0	4	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				1416.94	29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2486	003	0	1	01	01	H2486_003_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								8.00		24.00					3.00		9.00											8.00		24.00				3.00		0.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2486	003	0	1	01	01	H2486_003_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								8.00		24.00					3.00		9.00											8.00		24.00				3.00		0.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2486	003	0	1	01	01	H2486_003_0	3	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2486	003	0	1	01	01	H2486_003_0	3	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2486	003	0	1	01	01	H2486_003_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2486	003	0	1	01	01	H2486_003_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2486	003	0	1	01	01	H2486_003_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2486	003	0	1	01	01	H2486_003_0	3	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2486	003	0	1	01	01	H2486_003_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2486	003	0	1	01	01	H2486_003_0	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2491	004	0	1	01	01	H2491_004_0	7	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	004	0	1	01	01	H2491_004_0	7	Generic	4	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		50.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	004	0	1	01	01	H2491_004_0	7	Preferred Brand	4	000101	1	2	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												
H2491	004	0	1	01	01	H2491_004_0	7	Non-Preferred Drug	4	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				97.75	42		42																								42		42				42		42			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	004	0	1	01	01	H2491_004_0	7	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				2111.50	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	006	0	1	01	01	H2491_006_0	6	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	006	0	1	01	01	H2491_006_0	6	Generic	4	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		50.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	006	0	1	01	01	H2491_006_0	6	Preferred Brand	4	000101	1	2	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												
H2491	006	0	1	01	01	H2491_006_0	6	Non-Preferred Drug	4	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				88.44	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	006	0	1	01	01	H2491_006_0	6	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				2157.65	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	007	0	1	01	01	H2491_007_0	6	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		0.00				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	007	0	1	01	01	H2491_007_0	6	Generic	4	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		50.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	007	0	1	01	01	H2491_007_0	6	Preferred Brand	4	000101	1	2	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												
H2491	007	0	1	01	01	H2491_007_0	6	Non-Preferred Brand	4	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				78.72	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	007	0	1	01	01	H2491_007_0	6	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				2360.06	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	008	0	1	01	01	H2491_008_0	6	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	008	0	1	01	01	H2491_008_0	6	Generic	4	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		50.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	008	0	1	01	01	H2491_008_0	6	Preferred Brand	4	000101	1	2	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												
H2491	008	0	1	01	01	H2491_008_0	6	Non-Preferred Drug	4	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				88.73	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2491	008	0	1	01	01	H2491_008_0	6	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				2136.46	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2506	001	0	1	48	05	H2506_001_0	6	Generic Drugs	4	010000			1	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H2506	001	0	1	48	05	H2506_001_0	6	Brand Drugs	4	000010			2	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H2506	001	0	1	48	05	H2506_001_0	6	Non-Medicare Rx/OTC Drugs	4	010010			3	1	111		10	111		1	30	60	90				1	2	30	60	90					29	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			
H2531	001	0	1	48	05	H2531_001_0	4	Generic Drugs	4	010000			1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	3.30	0.00	3.30	0.00	3.30	0.00	3.30			
H2531	001	0	1	48	05	H2531_001_0	4	Brand Drugs	4	000010			2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	8.25	0.00	8.25	0.00	8.25	0.00	8.25			
H2531	001	0	1	48	05	H2531_001_0	4	Non-Medicare Rx/OTC Drugs	4	010010			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	6	Generic Drugs	4	010000			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	6	Brand Drugs	4	010010			2	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	6	Non-Medicare Rx/OTC Drugs	4	010010			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	001	0	1	01	01	H2563_001_0	7	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2563	001	0	1	01	01	H2563_001_0	7	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	8.00		24.00																					16.00																8.00				8.00		0.27						0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2563	001	0	1	01	01	H2563_001_0	7	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	40.00		120.00																					100.00																40.00				40.00		1.33						1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2563	001	0	1	01	01	H2563_001_0	7	Non-Preferred Brand	4	100100	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	80.00		240.00																					200.00																80.00				80.00		2.67						2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2563	001	0	1	01	01	H2563_001_0	7	Specialty Tier	4	010010	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31				831.92	28		28																				28															28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2563	003	0	1	01	01	H2563_003_0	7	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2563	003	0	1	01	01	H2563_003_0	7	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	14.00		42.00																					28.00																14.00				14.00		0.47						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2563	003	0	1	01	01	H2563_003_0	7	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		141.00																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2563	003	0	1	01	01	H2563_003_0	7	Non-Preferred Brand	4	100100	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	95.00		285.00																					237.50																95.00				95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2563	003	0	1	01	01	H2563_003_0	7	Specialty Tier	4	010010	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31				716.26	27		27																				27															27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2593	001	0	1	01	01	H2593_001_0	6	Preferred Generic	4	001000	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	001	0	1	01	01	H2593_001_0	6	Preferred Generic	4	001000	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	001	0	1	01	01	H2593_001_0	6	Generic	4	010000	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								12.50		37.50					7.50		22.50							18.75																12.50				12.50			0.42	0.25				0.40	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	001	0	1	01	01	H2593_001_0	6	Generic	4	010000	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								12.50		37.50					7.50		22.50							18.75																12.50				12.50			0.42	0.25				0.40	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	001	0	1	01	01	H2593_001_0	6	Preferred Brand	4	000001	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								45.00		135.00					40.00		120.00							100.00																45.00				45.00			1.50	1.33				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	001	0	1	01	01	H2593_001_0	6	Non-Preferred Drug	4	100100	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								95.00		285.00					85.00		255.00							212.50																95.00				95.00			3.17	2.83				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	001	0	1	01	01	H2593_001_0	6	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		31											538.00	33						538.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	001	0	1	01	01	H2593_001_0	6	Select Care Drugs	4	010010	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	001	0	1	01	01	H2593_001_0	6	Select Care Drugs	4	010010	1	2	6	3		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H2593	003	0	1	01	01	H2593_003_0	6	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	003	0	1	01	01	H2593_003_0	6	Preferred Generic	4	001000	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	003	0	1	01	01	H2593_003_0	6	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	7.50		22.50																					18.75																7.50				7.50		0.25						0.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	003	0	1	01	01	H2593_003_0	6	Generic	4	010000	1	2	2	3	110		01	100		1	30		90				1	2			90				30		31	7.50		22.50																					18.75																7.50				7.50		0.25						0.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	003	0	1	01	01	H2593_003_0	6	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	40.00		120.00																					100.00																40.00				40.00		1.33						1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	003	0	1	01	01	H2593_003_0	6	Non-Preferred Drug	4	100100	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	85.00		255.00																					212.50																85.00				85.00		2.83						2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	003	0	1	01	01	H2593_003_0	6	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31				538.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	003	0	1	01	01	H2593_003_0	6	Select Care Drugs	4	010010	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	003	0	1	01	01	H2593_003_0	6	Select Care Drugs	4	010010	1	2	6	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H2593	005	0	1	01	01	H2593_005_0	6	Preferred Generic	4	001000	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	005	0	1	01	01	H2593_005_0	6	Preferred Generic	4	001000	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	005	0	1	01	01	H2593_005_0	6	Generic	4	010000	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								12.50		37.50					7.50		22.50							18.75																12.50				12.50			0.42	0.25				0.40	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	005	0	1	01	01	H2593_005_0	6	Generic	4	010000	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								12.50		37.50					7.50		22.50							18.75																12.50				12.50			0.42	0.25				0.40	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	005	0	1	01	01	H2593_005_0	6	Preferred Brand	4	000001	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								45.00		135.00					40.00		120.00							100.00																45.00				45.00			1.50	1.33				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	005	0	1	01	01	H2593_005_0	6	Non-Preferred Drug	4	100100	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								95.00		285.00					85.00		255.00							212.50																95.00				95.00			3.17	2.83				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	005	0	1	01	01	H2593_005_0	6	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		31											538.00	33						538.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	005	0	1	01	01	H2593_005_0	6	Select Care Drugs	4	010010	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	005	0	1	01	01	H2593_005_0	6	Select Care Drugs	4	010010	1	2	6	3		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H2593	006	0	1	01	01	H2593_006_0	6	Preferred Generic	4	001000	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	006	0	1	01	01	H2593_006_0	6	Preferred Generic	4	001000	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	006	0	1	01	01	H2593_006_0	6	Generic	4	010000	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								12.50		37.50					7.50		22.50							18.75																12.50				12.50			0.42	0.25				0.40	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	006	0	1	01	01	H2593_006_0	6	Generic	4	010000	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								12.50		37.50					7.50		22.50							18.75																12.50				12.50			0.42	0.25				0.40	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	006	0	1	01	01	H2593_006_0	6	Preferred Brand	4	000001	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								45.00		135.00					40.00		120.00							100.00																45.00				45.00			1.50	1.33				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	006	0	1	01	01	H2593_006_0	6	Non-Preferred Drug	4	100100	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								95.00		285.00					85.00		255.00							212.50																95.00				95.00			3.17	2.83				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	006	0	1	01	01	H2593_006_0	6	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		31											538.00	33						538.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	006	0	1	01	01	H2593_006_0	6	Select Care Drugs	4	010010	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	006	0	1	01	01	H2593_006_0	6	Select Care Drugs	4	010010	1	2	6	3		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H2593	013	0	1	01	01	H2593_013_0	6	Preferred Generic	4	001000	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	013	0	1	01	01	H2593_013_0	6	Preferred Generic	4	001000	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	013	0	1	01	01	H2593_013_0	6	Generic	4	010000	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								12.50		37.50					7.50		22.50							18.75																12.50				12.50			0.42	0.25				0.40	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	013	0	1	01	01	H2593_013_0	6	Generic	4	010000	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								12.50		37.50					7.50		22.50							18.75																12.50				12.50			0.42	0.25				0.40	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	013	0	1	01	01	H2593_013_0	6	Preferred Brand	4	000001	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								45.00		135.00					40.00		120.00							100.00																45.00				45.00			1.50	1.33				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	013	0	1	01	01	H2593_013_0	6	Non-Preferred Drug	4	100100	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								95.00		285.00					85.00		255.00							212.50																95.00				95.00			3.17	2.83				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	013	0	1	01	01	H2593_013_0	6	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		31											538.00	33						538.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	013	0	1	01	01	H2593_013_0	6	Select Care Drugs	4	010010	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	013	0	1	01	01	H2593_013_0	6	Select Care Drugs	4	010010	1	2	6	3		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H2593	018	0	1	01	01	H2593_018_0	6	Preferred Generic	4	001000	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								10.00		30.00					5.00		15.00							12.50																10.00				10.00			0.33	0.17				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	018	0	1	01	01	H2593_018_0	6	Generic	4	010000	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								15.50		46.50					10.50		31.50							26.25																15.50				15.50			0.52	0.35				0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	018	0	1	01	01	H2593_018_0	6	Preferred Brand	4	000001	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								45.00		135.00					40.00		120.00							100.00																45.00				45.00			1.50	1.33				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	018	0	1	01	01	H2593_018_0	6	Non-Preferred Drug	4	100100	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								95.00		285.00					90.00		270.00							225.00																95.00				95.00			3.17	3.00				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	018	0	1	01	01	H2593_018_0	6	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		31											538.00	33						538.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	018	0	1	01	01	H2593_018_0	6	Select Care Drugs	4	010010	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								10.00		30.00					10.00		30.00							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												
H2593	019	0	1	01	01	H2593_019_0	6	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	019	0	1	01	01	H2593_019_0	6	Preferred Generic	4	001000	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	019	0	1	01	01	H2593_019_0	6	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	7.50		22.50																					18.75																7.50				7.50		0.25						0.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	019	0	1	01	01	H2593_019_0	6	Generic	4	010000	1	2	2	3	110		01	100		1	30		90				1	2			90				30		31	7.50		22.50																					18.75																7.50				7.50		0.25						0.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H2593	019	0	1	01	01	H2593_019_0	6	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	40.00		120.00																					100.00																40.00				40.00		1.33						1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	019	0	1	01	01	H2593_019_0	6	Non-Preferred Drug	4	100100	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	85.00		255.00																					212.50																85.00				85.00		2.83						2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	019	0	1	01	01	H2593_019_0	6	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31				538.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	019	0	1	01	01	H2593_019_0	6	Select Care Drugs	4	010010	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H2593	019	0	1	01	01	H2593_019_0	6	Select Care Drugs	4	010010	1	2	6	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H2610	005	0	1	01	01	H2610_005_0	7	Preferred Generic	4	001000	1	2	1	1		111	01	100		1				30	60	90	1	2			90				30		31								4.00	8.00	12.00					0.00	0.00	0.00							12.00																4.00				4.00			0.13	0.00				0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2610	005	0	1	01	01	H2610_005_0	7	Generic	4	010000	1	2	2	1		111	01	100		1				30	60	90	1	2			90				30		31								12.00	24.00	36.00					0.00	0.00	0.00							36.00																12.00				12.00			0.40	0.00				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2610	005	0	1	01	01	H2610_005_0	7	Preferred Brand	4	000001	1	2	3	1		111	01	100		1				30	60	90	1	2			90				30		31								47.00	94.00	141.00					34.00	68.00	102.00							141.00																47.00				47.00			1.57	1.13				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2610	005	0	1	01	01	H2610_005_0	7	Non-Preferred Brand	4	100000	1	2	4	1		111	01	100		1				30	60	90	1	2			90				30		31								100.00	200.00	300.00					65.00	130.00	195.00							300.00																100.00				100.00			3.33	2.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2610	005	0	1	01	01	H2610_005_0	7	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		31											1979.20	33						1979.20	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2610	006	0	1	01	01	H2610_006_0	7	Preferred Generic	4	001000	1	2	1	1		111	01	100		1				30	60	90	1	2			90				30		31								4.00	8.00	12.00					0.00	0.00	0.00							12.00																4.00				4.00			0.13	0.00				0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2610	006	0	1	01	01	H2610_006_0	7	Preferred Generic	4	001000	1	2	1	3		111	01	100		1				30	60	90	1	2			90				30		31								2.00	4.00	6.00					0.00	0.00	0.00							6.00																2.00				2.00			0.07	0.00				0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2610	006	0	1	01	01	H2610_006_0	7	Generic	4	010000	1	2	2	1		111	01	100		1				30	60	90	1	2			90				30		31								12.00	24.00	36.00					0.00	0.00	0.00							36.00																12.00				12.00			0.40	0.00				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2610	006	0	1	01	01	H2610_006_0	7	Generic	4	010000	1	2	2	3		111	01	100		1				30	60	90	1	2			90				30		31								5.00	10.00	15.00					0.00	0.00	0.00							15.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2610	006	0	1	01	01	H2610_006_0	7	Preferred Brand	4	000001	1	2	3	1		111	01	100		1				30	60	90	1	2			90				30		31								42.00	84.00	126.00					29.00	58.00	87.00							126.00																42.00				42.00			1.40	0.97				1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2610	006	0	1	01	01	H2610_006_0	7	Non-Preferred Brand	4	100000	1	2	4	1		111	01	100		1				30	60	90	1	2			90				30		31								80.00	160.00	240.00					55.00	110.00	165.00							240.00																80.00				80.00			2.67	1.83				2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2610	006	0	1	01	01	H2610_006_0	7	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		31											1503.82	33						1503.82	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2610	011	0	1	01	01	H2610_011_0	5	Preferred Generic	4	001000	1	2	1	1		111	01	100		1				30	60	90	1	2			90				30		31								7.00	14.00	21.00					0.00	0.00	0.00							21.00																7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2610	011	0	1	01	01	H2610_011_0	5	Generic	4	010000	1	2	2	1		111	01	100		1				30	60	90	1	2			90				30		31								10.00	20.00	30.00					0.00	0.00	0.00							30.00																10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2610	011	0	1	01	01	H2610_011_0	5	Preferred Brand	4	000001	1	2	3	1		111	01	100		1				30	60	90	1	2			90				30		31								42.00	84.00	126.00					37.00	74.00	111.00							126.00																42.00				42.00			1.40	1.23				1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2610	011	0	1	01	01	H2610_011_0	5	Non-Preferred Brand	4	100000	1	2	4	1		111	01	100		1				30	60	90	1	2			90				30		31								85.00	170.00	255.00					75.00	150.00	225.00							255.00																85.00				85.00			2.83	2.50				2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2610	011	0	1	01	01	H2610_011_0	5	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		31											2065.94	33						2065.94	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2610	015	0	1	01	01	H2610_015_0	7	Preferred Generic	4	001000	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	3.00	6.00	9.00																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2610	015	0	1	01	01	H2610_015_0	7	Generic	4	010000	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	6.00	12.00	18.00																					18.00																6.00				6.00		0.20						0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2610	015	0	1	01	01	H2610_015_0	7	Preferred Brand	4	000001	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												
H2610	015	0	1	01	01	H2610_015_0	7	Non-Preferred Brand	4	100000	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												
H2610	015	0	1	01	01	H2610_015_0	7	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31				2006.85	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2649	021	0	1	01	01	H2649_021_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	021	0	1	01	01	H2649_021_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	021	0	1	01	01	H2649_021_0	3	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								16.00		48.00					11.00		33.00											16.00		48.00				11.00		0.00				16.00				16.00			0.53	0.37		0.53	0.37	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	021	0	1	01	01	H2649_021_0	3	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								16.00		48.00					11.00		33.00											16.00		48.00				11.00		0.00				16.00				16.00			0.53	0.37		0.53	0.37	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	021	0	1	01	01	H2649_021_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	021	0	1	01	01	H2649_021_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	021	0	1	01	01	H2649_021_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	021	0	1	01	01	H2649_021_0	3	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	021	0	1	01	01	H2649_021_0	3	Specialty Tier	4	010010	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												
H2649	021	0	1	01	01	H2649_021_0	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	023	0	1	01	01	H2649_023_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	023	0	1	01	01	H2649_023_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	023	0	1	01	01	H2649_023_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								16.00		48.00					11.00		33.00											16.00		48.00				11.00		0.00				16.00				16.00			0.53	0.37		0.53	0.37	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	023	0	1	01	01	H2649_023_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								16.00		48.00					11.00		33.00											16.00		48.00				11.00		0.00				16.00				16.00			0.53	0.37		0.53	0.37	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	023	0	1	01	01	H2649_023_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	023	0	1	01	01	H2649_023_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	023	0	1	01	01	H2649_023_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	023	0	1	01	01	H2649_023_0	4	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	023	0	1	01	01	H2649_023_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	023	0	1	01	01	H2649_023_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	028	0	1	01	01	H2649_028_0	4	Preferred Generic	3	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	028	0	1	01	01	H2649_028_0	4	Generic	3	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								16.00		48.00					11.00		33.00											16.00		48.00				11.00		0.00				16.00				16.00			0.53	0.37		0.53	0.37	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	028	0	1	01	01	H2649_028_0	4	Preferred Brand	3	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	028	0	1	01	01	H2649_028_0	4	Non-Preferred Drug	3	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	028	0	1	01	01	H2649_028_0	4	Specialty Tier	3	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	029	0	1	01	01	H2649_029_0	5	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	029	0	1	01	01	H2649_029_0	5	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	029	0	1	01	01	H2649_029_0	5	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								17.00		51.00					12.00		36.00											17.00		51.00				12.00		0.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	029	0	1	01	01	H2649_029_0	5	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								17.00		51.00					12.00		36.00											17.00		51.00				12.00		0.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	029	0	1	01	01	H2649_029_0	5	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	029	0	1	01	01	H2649_029_0	5	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	029	0	1	01	01	H2649_029_0	5	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	029	0	1	01	01	H2649_029_0	5	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	029	0	1	01	01	H2649_029_0	5	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	029	0	1	01	01	H2649_029_0	5	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	030	0	1	01	01	H2649_030_0	5	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	030	0	1	01	01	H2649_030_0	5	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	030	0	1	01	01	H2649_030_0	5	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	030	0	1	01	01	H2649_030_0	5	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	030	0	1	01	01	H2649_030_0	5	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	030	0	1	01	01	H2649_030_0	5	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	030	0	1	01	01	H2649_030_0	5	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	030	0	1	01	01	H2649_030_0	5	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	030	0	1	01	01	H2649_030_0	5	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	030	0	1	01	01	H2649_030_0	5	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	031	0	1	01	01	H2649_031_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	031	0	1	01	01	H2649_031_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	031	0	1	01	01	H2649_031_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	031	0	1	01	01	H2649_031_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	031	0	1	01	01	H2649_031_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	031	0	1	01	01	H2649_031_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	031	0	1	01	01	H2649_031_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	031	0	1	01	01	H2649_031_0	4	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	031	0	1	01	01	H2649_031_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	031	0	1	01	01	H2649_031_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	032	0	1	01	01	H2649_032_0	5	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	032	0	1	01	01	H2649_032_0	5	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	032	0	1	01	01	H2649_032_0	5	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	032	0	1	01	01	H2649_032_0	5	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	032	0	1	01	01	H2649_032_0	5	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	032	0	1	01	01	H2649_032_0	5	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	032	0	1	01	01	H2649_032_0	5	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	032	0	1	01	01	H2649_032_0	5	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	032	0	1	01	01	H2649_032_0	5	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	032	0	1	01	01	H2649_032_0	5	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	033	0	1	01	01	H2649_033_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								9.00		27.00					4.00		12.00											9.00		27.00				4.00		0.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	033	0	1	01	01	H2649_033_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								9.00		27.00					4.00		12.00											9.00		27.00				4.00		0.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	033	0	1	01	01	H2649_033_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								15.00		45.00					10.00		30.00											15.00		45.00				10.00		0.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	033	0	1	01	01	H2649_033_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								15.00		45.00					10.00		30.00											15.00		45.00				10.00		0.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	033	0	1	01	01	H2649_033_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	033	0	1	01	01	H2649_033_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	033	0	1	01	01	H2649_033_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	033	0	1	01	01	H2649_033_0	4	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	033	0	1	01	01	H2649_033_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	033	0	1	01	01	H2649_033_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	034	0	1	01	01	H2649_034_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	034	0	1	01	01	H2649_034_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	034	0	1	01	01	H2649_034_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	034	0	1	01	01	H2649_034_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	034	0	1	01	01	H2649_034_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	034	0	1	01	01	H2649_034_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	034	0	1	01	01	H2649_034_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	034	0	1	01	01	H2649_034_0	4	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	034	0	1	01	01	H2649_034_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	034	0	1	01	01	H2649_034_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	039	0	1	01	01	H2649_039_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								9.00		27.00					4.00		12.00											9.00		27.00				4.00		0.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	039	0	1	01	01	H2649_039_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								9.00		27.00					4.00		12.00											9.00		27.00				4.00		0.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	039	0	1	01	01	H2649_039_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								15.00		45.00					10.00		30.00											15.00		45.00				10.00		0.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	039	0	1	01	01	H2649_039_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								15.00		45.00					10.00		30.00											15.00		45.00				10.00		0.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	039	0	1	01	01	H2649_039_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	039	0	1	01	01	H2649_039_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	039	0	1	01	01	H2649_039_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	039	0	1	01	01	H2649_039_0	4	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	039	0	1	01	01	H2649_039_0	4	Specialty Tier	4	010010	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												
H2649	039	0	1	01	01	H2649_039_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	043	0	1	01	01	H2649_043_0	5	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	043	0	1	01	01	H2649_043_0	5	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	043	0	1	01	01	H2649_043_0	5	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								15.00		45.00					10.00		30.00											15.00		45.00				10.00		0.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	043	0	1	01	01	H2649_043_0	5	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								15.00		45.00					10.00		30.00											15.00		45.00				10.00		0.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	043	0	1	01	01	H2649_043_0	5	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	043	0	1	01	01	H2649_043_0	5	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	043	0	1	01	01	H2649_043_0	5	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	043	0	1	01	01	H2649_043_0	5	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	043	0	1	01	01	H2649_043_0	5	Specialty Tier	4	010010	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												
H2649	043	0	1	01	01	H2649_043_0	5	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	045	0	1	01	01	H2649_045_0	6	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								7.00		21.00					2.00		6.00											7.00		21.00				2.00		0.00				7.00				7.00			0.23	0.07		0.23	0.07	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	045	0	1	01	01	H2649_045_0	6	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								7.00		21.00					2.00		6.00											7.00		21.00				2.00		0.00				7.00				7.00			0.23	0.07		0.23	0.07	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	045	0	1	01	01	H2649_045_0	6	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								15.00		45.00					10.00		30.00											15.00		45.00				10.00		0.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	045	0	1	01	01	H2649_045_0	6	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								15.00		45.00					10.00		30.00											15.00		45.00				10.00		0.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	045	0	1	01	01	H2649_045_0	6	Preferred Brand	4	010001	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												
H2649	045	0	1	01	01	H2649_045_0	6	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	045	0	1	01	01	H2649_045_0	6	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	045	0	1	01	01	H2649_045_0	6	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	045	0	1	01	01	H2649_045_0	6	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	045	0	1	01	01	H2649_045_0	6	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	046	0	1	01	01	H2649_046_0	6	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								8.00		24.00					3.00		9.00											8.00		24.00				3.00		0.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	046	0	1	01	01	H2649_046_0	6	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								8.00		24.00					3.00		9.00											8.00		24.00				3.00		0.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	046	0	1	01	01	H2649_046_0	6	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								13.00		39.00					8.00		24.00											13.00		39.00				8.00		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												
H2649	046	0	1	01	01	H2649_046_0	6	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								13.00		39.00					8.00		24.00											13.00		39.00				8.00		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										2	3	
H2649	046	0	1	01	01	H2649_046_0	6	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	046	0	1	01	01	H2649_046_0	6	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	046	0	1	01	01	H2649_046_0	6	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	046	0	1	01	01	H2649_046_0	6	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	046	0	1	01	01	H2649_046_0	6	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	046	0	1	01	01	H2649_046_0	6	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	047	0	1	01	01	H2649_047_0	5	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								8.00		24.00					3.00		9.00											8.00		24.00				3.00		0.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	047	0	1	01	01	H2649_047_0	5	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								8.00		24.00					3.00		9.00											8.00		24.00				3.00		0.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	047	0	1	01	01	H2649_047_0	5	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								19.00		57.00					14.00		42.00											19.00		57.00				14.00		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												
H2649	047	0	1	01	01	H2649_047_0	5	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								19.00		57.00					14.00		42.00											19.00		57.00				14.00		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										2	3	
H2649	047	0	1	01	01	H2649_047_0	5	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	047	0	1	01	01	H2649_047_0	5	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	047	0	1	01	01	H2649_047_0	5	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	047	0	1	01	01	H2649_047_0	5	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	047	0	1	01	01	H2649_047_0	5	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	047	0	1	01	01	H2649_047_0	5	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	048	0	1	01	01	H2649_048_0	4	Preferred Generic	3	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	048	0	1	01	01	H2649_048_0	4	Generic	3	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					19.00		57.00											20.00		60.00				19.00		0.00				20.00				20.00			0.67	0.63		0.67	0.63	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	048	0	1	01	01	H2649_048_0	4	Preferred Brand	3	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	048	0	1	01	01	H2649_048_0	4	Non-Preferred Drug	3	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	048	0	1	01	01	H2649_048_0	4	Specialty Tier	3	010010	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	049	0	1	01	01	H2649_049_0	5	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								8.00		24.00					3.00		9.00											8.00		24.00				3.00		0.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	049	0	1	01	01	H2649_049_0	5	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								8.00		24.00					3.00		9.00											8.00		24.00				3.00		0.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	049	0	1	01	01	H2649_049_0	5	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								11.00		33.00					6.00		18.00											11.00		33.00				6.00		0.00				11.00				11.00			0.37	0.20		0.37	0.20	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	049	0	1	01	01	H2649_049_0	5	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								11.00		33.00					6.00		18.00											11.00		33.00				6.00		0.00				11.00				11.00			0.37	0.20		0.37	0.20	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	049	0	1	01	01	H2649_049_0	5	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	049	0	1	01	01	H2649_049_0	5	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	049	0	1	01	01	H2649_049_0	5	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	049	0	1	01	01	H2649_049_0	5	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	049	0	1	01	01	H2649_049_0	5	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	049	0	1	01	01	H2649_049_0	5	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	050	0	1	01	01	H2649_050_0	5	Preferred Generic	3	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	050	0	1	01	01	H2649_050_0	5	Generic	3	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	050	0	1	01	01	H2649_050_0	5	Preferred Brand	3	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	050	0	1	01	01	H2649_050_0	5	Non-Preferred Drug	3	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	050	0	1	01	01	H2649_050_0	5	Specialty Tier	3	010010	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												
H2649	051	0	1	01	01	H2649_051_0	5	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	051	0	1	01	01	H2649_051_0	5	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	051	0	1	01	01	H2649_051_0	5	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								17.00		51.00					12.00		36.00											17.00		51.00				12.00		0.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	051	0	1	01	01	H2649_051_0	5	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								17.00		51.00					12.00		36.00											17.00		51.00				12.00		0.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	051	0	1	01	01	H2649_051_0	5	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	051	0	1	01	01	H2649_051_0	5	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	051	0	1	01	01	H2649_051_0	5	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	051	0	1	01	01	H2649_051_0	5	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	051	0	1	01	01	H2649_051_0	5	Specialty Tier	4	010010	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												
H2649	051	0	1	01	01	H2649_051_0	5	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	052	0	1	01	01	H2649_052_0	5	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								8.00		24.00					3.00		9.00											8.00		24.00				3.00		0.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	052	0	1	01	01	H2649_052_0	5	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								8.00		24.00					3.00		9.00											8.00		24.00				3.00		0.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	052	0	1	01	01	H2649_052_0	5	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								19.00		57.00					14.00		42.00											19.00		57.00				14.00		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												
H2649	052	0	1	01	01	H2649_052_0	5	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								19.00		57.00					14.00		42.00											19.00		57.00				14.00		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										2	3	
H2649	052	0	1	01	01	H2649_052_0	5	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	052	0	1	01	01	H2649_052_0	5	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	052	0	1	01	01	H2649_052_0	5	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	052	0	1	01	01	H2649_052_0	5	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	052	0	1	01	01	H2649_052_0	5	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	052	0	1	01	01	H2649_052_0	5	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	053	0	1	01	01	H2649_053_0	5	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								7.00		21.00					2.00		6.00											7.00		21.00				2.00		0.00				7.00				7.00			0.23	0.07		0.23	0.07	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	053	0	1	01	01	H2649_053_0	5	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								7.00		21.00					2.00		6.00											7.00		21.00				2.00		0.00				7.00				7.00			0.23	0.07		0.23	0.07	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	053	0	1	01	01	H2649_053_0	5	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								15.00		45.00					10.00		30.00											15.00		45.00				10.00		0.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	053	0	1	01	01	H2649_053_0	5	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								15.00		45.00					10.00		30.00											15.00		45.00				10.00		0.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	053	0	1	01	01	H2649_053_0	5	Preferred Brand	4	010001	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												
H2649	053	0	1	01	01	H2649_053_0	5	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					45.00		135.00											47.00		141.00				45.00		125.00				47.00				47.00			1.57	1.50		1.57	1.50	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	053	0	1	01	01	H2649_053_0	5	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	053	0	1	01	01	H2649_053_0	5	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	053	0	1	01	01	H2649_053_0	5	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	053	0	1	01	01	H2649_053_0	5	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	054	0	1	01	01	H2649_054_0	5	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								8.00		24.00					3.00		9.00											8.00		24.00				3.00		0.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	054	0	1	01	01	H2649_054_0	5	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								8.00		24.00					3.00		9.00											8.00		24.00				3.00		0.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	054	0	1	01	01	H2649_054_0	5	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								13.00		39.00					8.00		24.00											13.00		39.00				8.00		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												
H2649	054	0	1	01	01	H2649_054_0	5	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								13.00		39.00					8.00		24.00											13.00		39.00				8.00		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										2	3	
H2649	054	0	1	01	01	H2649_054_0	5	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	054	0	1	01	01	H2649_054_0	5	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	054	0	1	01	01	H2649_054_0	5	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	054	0	1	01	01	H2649_054_0	5	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	054	0	1	01	01	H2649_054_0	5	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	054	0	1	01	01	H2649_054_0	5	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	055	0	1	01	01	H2649_055_0	5	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								8.00		24.00					3.00		9.00											8.00		24.00				3.00		0.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	055	0	1	01	01	H2649_055_0	5	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								8.00		24.00					3.00		9.00											8.00		24.00				3.00		0.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	055	0	1	01	01	H2649_055_0	5	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								15.00		45.00					10.00		30.00											15.00		45.00				10.00		0.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	055	0	1	01	01	H2649_055_0	5	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								15.00		45.00					10.00		30.00											15.00		45.00				10.00		0.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	055	0	1	01	01	H2649_055_0	5	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	055	0	1	01	01	H2649_055_0	5	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	055	0	1	01	01	H2649_055_0	5	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	055	0	1	01	01	H2649_055_0	5	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	055	0	1	01	01	H2649_055_0	5	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	055	0	1	01	01	H2649_055_0	5	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	056	0	1	02	01	H2649_056_0	6	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					8.00		24.00											10.00		30.00				8.00		0.00				10.00				10.00			0.33	0.27		0.33	0.27	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	056	0	1	02	01	H2649_056_0	6	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					8.00		24.00											10.00		30.00				8.00		0.00				10.00				10.00			0.33	0.27		0.33	0.27	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	056	0	1	02	01	H2649_056_0	6	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	056	0	1	02	01	H2649_056_0	6	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	056	0	1	02	01	H2649_056_0	6	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	056	0	1	02	01	H2649_056_0	6	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	056	0	1	02	01	H2649_056_0	6	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	056	0	1	02	01	H2649_056_0	6	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	056	0	1	02	01	H2649_056_0	6	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	056	0	1	02	01	H2649_056_0	6	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	059	1	1	01	01	H2649_059_1	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	059	1	1	01	01	H2649_059_1	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	059	1	1	01	01	H2649_059_1	4	Generic	4	010001	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								16.00		48.00					11.00		33.00											16.00		48.00				11.00		0.00				16.00				16.00			0.53	0.37		0.53	0.37	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	059	1	1	01	01	H2649_059_1	4	Generic	4	010001	3	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								16.00		48.00					11.00		33.00											16.00		48.00				11.00		0.00				16.00				16.00			0.53	0.37		0.53	0.37	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	3
H2649	059	1	1	01	01	H2649_059_1	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	059	1	1	01	01	H2649_059_1	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	059	1	1	01	01	H2649_059_1	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	059	1	1	01	01	H2649_059_1	4	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	059	1	1	01	01	H2649_059_1	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	059	1	1	01	01	H2649_059_1	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	059	2	1	01	01	H2649_059_2	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	059	2	1	01	01	H2649_059_2	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	059	2	1	01	01	H2649_059_2	4	Generic	4	010001	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								16.00		48.00					11.00		33.00											16.00		48.00				11.00		0.00				16.00				16.00			0.53	0.37		0.53	0.37	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	059	2	1	01	01	H2649_059_2	4	Generic	4	010001	3	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								16.00		48.00					11.00		33.00											16.00		48.00				11.00		0.00				16.00				16.00			0.53	0.37		0.53	0.37	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	3
H2649	059	2	1	01	01	H2649_059_2	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	059	2	1	01	01	H2649_059_2	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	059	2	1	01	01	H2649_059_2	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	059	2	1	01	01	H2649_059_2	4	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	059	2	1	01	01	H2649_059_2	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	059	2	1	01	01	H2649_059_2	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	060	0	1	02	01	H2649_060_0	5	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	060	0	1	02	01	H2649_060_0	5	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	060	0	1	02	01	H2649_060_0	5	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								15.00		45.00					10.00		30.00											15.00		45.00				10.00		0.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	060	0	1	02	01	H2649_060_0	5	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								15.00		45.00					10.00		30.00											15.00		45.00				10.00		0.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	060	0	1	02	01	H2649_060_0	5	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	060	0	1	02	01	H2649_060_0	5	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	060	0	1	02	01	H2649_060_0	5	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	060	0	1	02	01	H2649_060_0	5	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	060	0	1	02	01	H2649_060_0	5	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	060	0	1	02	01	H2649_060_0	5	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	061	1	1	01	01	H2649_061_1	5	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	061	1	1	01	01	H2649_061_1	5	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	061	1	1	01	01	H2649_061_1	5	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								15.00		45.00					10.00		30.00											15.00		45.00				10.00		0.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	061	1	1	01	01	H2649_061_1	5	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								15.00		45.00					10.00		30.00											15.00		45.00				10.00		0.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	061	1	1	01	01	H2649_061_1	5	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	061	1	1	01	01	H2649_061_1	5	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	061	1	1	01	01	H2649_061_1	5	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	061	1	1	01	01	H2649_061_1	5	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	061	1	1	01	01	H2649_061_1	5	Specialty Tier	4	010010	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												
H2649	061	1	1	01	01	H2649_061_1	5	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	061	2	1	01	01	H2649_061_2	5	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	061	2	1	01	01	H2649_061_2	5	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	061	2	1	01	01	H2649_061_2	5	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								15.00		45.00					10.00		30.00											15.00		45.00				10.00		0.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	061	2	1	01	01	H2649_061_2	5	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								15.00		45.00					10.00		30.00											15.00		45.00				10.00		0.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	061	2	1	01	01	H2649_061_2	5	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	061	2	1	01	01	H2649_061_2	5	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	061	2	1	01	01	H2649_061_2	5	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	061	2	1	01	01	H2649_061_2	5	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	061	2	1	01	01	H2649_061_2	5	Specialty Tier	4	010010	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												
H2649	061	2	1	01	01	H2649_061_2	5	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	062	1	1	01	01	H2649_062_1	5	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	062	1	1	01	01	H2649_062_1	5	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	062	1	1	01	01	H2649_062_1	5	Generic	4	010001	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								16.00		48.00					11.00		33.00											16.00		48.00				11.00		0.00				16.00				16.00			0.53	0.37		0.53	0.37	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	062	1	1	01	01	H2649_062_1	5	Generic	4	010001	3	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								16.00		48.00					11.00		33.00											16.00		48.00				11.00		0.00				16.00				16.00			0.53	0.37		0.53	0.37	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	3
H2649	062	1	1	01	01	H2649_062_1	5	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	062	1	1	01	01	H2649_062_1	5	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	062	1	1	01	01	H2649_062_1	5	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	062	1	1	01	01	H2649_062_1	5	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	062	1	1	01	01	H2649_062_1	5	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	062	1	1	01	01	H2649_062_1	5	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	062	2	1	01	01	H2649_062_2	5	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	062	2	1	01	01	H2649_062_2	5	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	062	2	1	01	01	H2649_062_2	5	Generic	4	010001	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								16.00		48.00					11.00		33.00											16.00		48.00				11.00		0.00				16.00				16.00			0.53	0.37		0.53	0.37	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	062	2	1	01	01	H2649_062_2	5	Generic	4	010001	3	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								16.00		48.00					11.00		33.00											16.00		48.00				11.00		0.00				16.00				16.00			0.53	0.37		0.53	0.37	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	3
H2649	062	2	1	01	01	H2649_062_2	5	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	062	2	1	01	01	H2649_062_2	5	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	062	2	1	01	01	H2649_062_2	5	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	062	2	1	01	01	H2649_062_2	5	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2649	062	2	1	01	01	H2649_062_2	5	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2649	062	2	1	01	01	H2649_062_2	5	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2663	002	0	1	01	01	H2663_002_0	5	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	002	0	1	01	01	H2663_002_0	5	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2663	002	0	1	01	01	H2663_002_0	5	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	002	0	1	01	01	H2663_002_0	5	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2663	002	0	1	01	01	H2663_002_0	5	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	5	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	5	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	005	0	1	01	01	H2663_005_0	5	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	005	0	1	01	01	H2663_005_0	5	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2663	005	0	1	01	01	H2663_005_0	5	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	005	0	1	01	01	H2663_005_0	5	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2663	005	0	1	01	01	H2663_005_0	5	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	5	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	5	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	006	0	1	02	01	H2663_006_0	5	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	006	0	1	02	01	H2663_006_0	5	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2663	006	0	1	02	01	H2663_006_0	5	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	006	0	1	02	01	H2663_006_0	5	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2663	006	0	1	02	01	H2663_006_0	5	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	5	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	5	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	015	0	1	02	01	H2663_015_0	5	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	015	0	1	02	01	H2663_015_0	5	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2663	015	0	1	02	01	H2663_015_0	5	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	015	0	1	02	01	H2663_015_0	5	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2663	015	0	1	02	01	H2663_015_0	5	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	015	0	1	02	01	H2663_015_0	5	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	015	0	1	02	01	H2663_015_0	5	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	016	0	1	01	01	H2663_016_0	4	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	016	0	1	01	01	H2663_016_0	4	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2663	016	0	1	01	01	H2663_016_0	4	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	016	0	1	01	01	H2663_016_0	4	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2663	016	0	1	01	01	H2663_016_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	016	0	1	01	01	H2663_016_0	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	016	0	1	01	01	H2663_016_0	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	017	0	1	01	01	H2663_017_0	5	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	017	0	1	01	01	H2663_017_0	5	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2663	017	0	1	01	01	H2663_017_0	5	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	017	0	1	01	01	H2663_017_0	5	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2663	017	0	1	01	01	H2663_017_0	5	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	5	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	5	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	021	0	1	01	01	H2663_021_0	4	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	021	0	1	01	01	H2663_021_0	4	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2663	021	0	1	01	01	H2663_021_0	4	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	021	0	1	01	01	H2663_021_0	4	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2663	021	0	1	01	01	H2663_021_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	01	01	H2663_021_0	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	01	01	H2663_021_0	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	023	0	1	02	01	H2663_023_0	4	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	023	0	1	02	01	H2663_023_0	4	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2663	023	0	1	02	01	H2663_023_0	4	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	023	0	1	02	01	H2663_023_0	4	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2663	023	0	1	02	01	H2663_023_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	024	0	1	01	01	H2663_024_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	024	0	1	01	01	H2663_024_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2663	024	0	1	01	01	H2663_024_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	024	0	1	01	01	H2663_024_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2663	024	0	1	01	01	H2663_024_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	024	0	1	01	01	H2663_024_0	3	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	024	0	1	01	01	H2663_024_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	026	0	1	01	01	H2663_026_0	4	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	026	0	1	01	01	H2663_026_0	4	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2663	026	0	1	01	01	H2663_026_0	4	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	026	0	1	01	01	H2663_026_0	4	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2663	026	0	1	01	01	H2663_026_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	027	0	1	01	01	H2663_027_0	4	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	027	0	1	01	01	H2663_027_0	4	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2663	027	0	1	01	01	H2663_027_0	4	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	027	0	1	01	01	H2663_027_0	4	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2663	027	0	1	01	01	H2663_027_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	027	0	1	01	01	H2663_027_0	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	027	0	1	01	01	H2663_027_0	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	028	0	1	01	01	H2663_028_0	4	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	028	0	1	01	01	H2663_028_0	4	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2663	028	0	1	01	01	H2663_028_0	4	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	028	0	1	01	01	H2663_028_0	4	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2663	028	0	1	01	01	H2663_028_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	01	01	H2663_028_0	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	01	01	H2663_028_0	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	029	0	1	01	01	H2663_029_0	4	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	029	0	1	01	01	H2663_029_0	4	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2663	029	0	1	01	01	H2663_029_0	4	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	029	0	1	01	01	H2663_029_0	4	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2663	029	0	1	01	01	H2663_029_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	01	01	H2663_029_0	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	01	01	H2663_029_0	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	030	0	1	01	01	H2663_030_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	030	0	1	01	01	H2663_030_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2663	030	0	1	01	01	H2663_030_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2663	030	0	1	01	01	H2663_030_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2663	030	0	1	01	01	H2663_030_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	030	0	1	01	01	H2663_030_0	3	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	030	0	1	01	01	H2663_030_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2758	002	0	1	01	01	H2758_002_0	7	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								7.00	7.00	7.00					0.00	0.00	0.00											7.00	7.00	7.00				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 Brand, Specialty Tier, Select Care Drugs												
H2758	002	0	1	01	01	H2758_002_0	7	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								7.00	7.00	7.00					0.00	0.00	0.00											7.00	7.00	7.00				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 Brand, Specialty Tier, Select Care Drugs										1		
H2758	002	0	1	01	01	H2758_002_0	7	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								14.00	21.00	28.00					7.00	14.00	21.00											14.00	21.00	28.00				7.00	14.00	21.00					14.00			7.00			0.47	0.23		0.47	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2758	002	0	1	01	01	H2758_002_0	7	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								42.00	77.00	112.00					35.00	70.00	105.00											42.00	77.00	112.00				35.00	70.00	105.00					42.00			35.00			1.40	1.17		1.40	1.17	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2758	002	0	1	01	01	H2758_002_0	7	Non-Preferred Brand	4	110000	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								92.00	177.00	262.00					85.00	170.00	255.00											92.00	177.00	262.00				85.00	170.00	255.00					92.00			85.00			3.07	2.83		3.07	2.83	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2758	002	0	1	01	01	H2758_002_0	7	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											999.00	33						999.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2758	002	0	1	01	01	H2758_002_0	7	Select Care Drugs	4	010000	1	2	6	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								7.00	7.00	0.00					7.00	7.00	0.00											7.00	7.00	0.00				7.00	7.00	0.00					7.00			7.00			0.23	0.23		0.23	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2758	002	0	1	01	01	H2758_002_0	7	Select Care Drugs	4	010000	1	2	6	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								7.00	7.00	0.00					7.00	7.00	0.00											7.00	7.00	0.00				7.00	7.00	0.00					7.00			7.00			0.23	0.23		0.23	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H2758	004	0	1	01	01	H2758_004_0	7	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								7.00	7.00	7.00					0.00	0.00	0.00											7.00	7.00	7.00				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 Brand, Specialty Tier, Select Care Drugs												
H2758	004	0	1	01	01	H2758_004_0	7	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								7.00	7.00	7.00					0.00	0.00	0.00											7.00	7.00	7.00				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 Brand, Specialty Tier, Select Care Drugs										1		
H2758	004	0	1	01	01	H2758_004_0	7	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								14.00	21.00	28.00					7.00	14.00	21.00											14.00	21.00	28.00				7.00	14.00	21.00					14.00			7.00			0.47	0.23		0.47	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2758	004	0	1	01	01	H2758_004_0	7	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								42.00	77.00	112.00					35.00	70.00	105.00											42.00	77.00	112.00				35.00	70.00	105.00					42.00			35.00			1.40	1.17		1.40	1.17	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2758	004	0	1	01	01	H2758_004_0	7	Non-Preferred Brand	4	110000	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								92.00	177.00	262.00					85.00	170.00	255.00											92.00	177.00	262.00				85.00	170.00	255.00					92.00			85.00			3.07	2.83		3.07	2.83	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2758	004	0	1	01	01	H2758_004_0	7	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											999.00	33						999.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2758	004	0	1	01	01	H2758_004_0	7	Select Care Drugs	4	010000	1	2	6	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								7.00	7.00	0.00					7.00	7.00	0.00											7.00	7.00	0.00				7.00	7.00	0.00					7.00			7.00			0.23	0.23		0.23	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2758	004	0	1	01	01	H2758_004_0	7	Select Care Drugs	4	010000	1	2	6	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								7.00	7.00	0.00					7.00	7.00	0.00											7.00	7.00	0.00				7.00	7.00	0.00					7.00			7.00			0.23	0.23		0.23	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H2758	005	0	1	01	01	H2758_005_0	6	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								7.00	7.00	7.00					0.00	0.00	0.00											7.00	7.00	7.00				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 Brand, Specialty Tier, Select Care Drugs												
H2758	005	0	1	01	01	H2758_005_0	6	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								7.00	7.00	7.00					0.00	0.00	0.00											7.00	7.00	7.00				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 Brand, Specialty Tier, Select Care Drugs										1		
H2758	005	0	1	01	01	H2758_005_0	6	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								14.00	21.00	28.00					7.00	14.00	21.00											14.00	21.00	28.00				7.00	14.00	21.00					14.00			7.00			0.47	0.23		0.47	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2758	005	0	1	01	01	H2758_005_0	6	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								42.00	77.00	112.00					35.00	70.00	105.00											42.00	77.00	112.00				35.00	70.00	105.00					42.00			35.00			1.40	1.17		1.40	1.17	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2758	005	0	1	01	01	H2758_005_0	6	Non-Preferred Brand	4	110000	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								92.00	177.00	262.00					85.00	170.00	255.00											92.00	177.00	262.00				85.00	170.00	255.00					92.00			85.00			3.07	2.83		3.07	2.83	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2758	005	0	1	01	01	H2758_005_0	6	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											999.00	33						999.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2758	005	0	1	01	01	H2758_005_0	6	Select Care Drugs	4	010000	1	2	6	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								7.00	7.00	0.00					7.00	7.00	0.00											7.00	7.00	0.00				7.00	7.00	0.00					7.00			7.00			0.23	0.23		0.23	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2758	005	0	1	01	01	H2758_005_0	6	Select Care Drugs	4	010000	1	2	6	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								7.00	7.00	0.00					7.00	7.00	0.00											7.00	7.00	0.00				7.00	7.00	0.00					7.00			7.00			0.23	0.23		0.23	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H2758	006	0	1	01	01	H2758_006_0	6	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								7.00	7.00	7.00					0.00	0.00	0.00											7.00	7.00	7.00				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 Brand, Specialty Tier, Select Care Drugs												
H2758	006	0	1	01	01	H2758_006_0	6	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								7.00	7.00	7.00					0.00	0.00	0.00											7.00	7.00	7.00				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 Brand, Specialty Tier, Select Care Drugs										1		
H2758	006	0	1	01	01	H2758_006_0	6	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								14.00	21.00	28.00					7.00	14.00	21.00											14.00	21.00	28.00				7.00	14.00	21.00					14.00			7.00			0.47	0.23		0.47	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2758	006	0	1	01	01	H2758_006_0	6	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								42.00	77.00	112.00					35.00	70.00	105.00											42.00	77.00	112.00				35.00	70.00	105.00					42.00			35.00			1.40	1.17		1.40	1.17	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2758	006	0	1	01	01	H2758_006_0	6	Non-Preferred Brand	4	110000	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								92.00	177.00	262.00					85.00	170.00	255.00											92.00	177.00	262.00				85.00	170.00	255.00					92.00			85.00			3.07	2.83		3.07	2.83	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2758	006	0	1	01	01	H2758_006_0	6	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											999.00	33						999.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2758	006	0	1	01	01	H2758_006_0	6	Select Care Drugs	4	010000	1	2	6	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								7.00	7.00	0.00					7.00	7.00	0.00											7.00	7.00	0.00				7.00	7.00	0.00					7.00			7.00			0.23	0.23		0.23	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2758	006	0	1	01	01	H2758_006_0	6	Select Care Drugs	4	010000	1	2	6	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								7.00	7.00	0.00					7.00	7.00	0.00											7.00	7.00	0.00				7.00	7.00	0.00					7.00			7.00			0.23	0.23		0.23	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H2758	007	0	1	01	01	H2758_007_0	6	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								7.00	7.00	7.00					0.00	0.00	0.00											7.00	7.00	7.00				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 Brand, Specialty Tier, Select Care Drugs												
H2758	007	0	1	01	01	H2758_007_0	6	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								7.00	7.00	7.00					0.00	0.00	0.00											7.00	7.00	7.00				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 Brand, Specialty Tier, Select Care Drugs										1		
H2758	007	0	1	01	01	H2758_007_0	6	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								14.00	21.00	28.00					7.00	14.00	21.00											14.00	21.00	28.00				7.00	14.00	21.00					14.00			7.00			0.47	0.23		0.47	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2758	007	0	1	01	01	H2758_007_0	6	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								42.00	77.00	112.00					35.00	70.00	105.00											42.00	77.00	112.00				35.00	70.00	105.00					42.00			35.00			1.40	1.17		1.40	1.17	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2758	007	0	1	01	01	H2758_007_0	6	Non-Preferred Brand	4	110000	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								92.00	177.00	262.00					85.00	170.00	255.00											92.00	177.00	262.00				85.00	170.00	255.00					92.00			85.00			3.07	2.83		3.07	2.83	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2758	007	0	1	01	01	H2758_007_0	6	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											999.00	33						999.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2758	007	0	1	01	01	H2758_007_0	6	Select Care Drugs	4	010000	1	2	6	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								7.00	7.00	0.00					7.00	7.00	0.00											7.00	7.00	0.00				7.00	7.00	0.00					7.00			7.00			0.23	0.23		0.23	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2758	007	0	1	01	01	H2758_007_0	6	Select Care Drugs	4	010000	1	2	6	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								7.00	7.00	0.00					7.00	7.00	0.00											7.00	7.00	0.00				7.00	7.00	0.00					7.00			7.00			0.23	0.23		0.23	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H2758	008	0	1	02	01	H2758_008_0	6	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								7.00	7.00	7.00					0.00	0.00	0.00											7.00	7.00	7.00				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 Brand, Specialty Tier, Select Care Drugs												
H2758	008	0	1	02	01	H2758_008_0	6	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								7.00	7.00	7.00					0.00	0.00	0.00											7.00	7.00	7.00				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 Brand, Specialty Tier, Select Care Drugs										1		
H2758	008	0	1	02	01	H2758_008_0	6	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								14.00	21.00	28.00					7.00	14.00	21.00											14.00	21.00	28.00				7.00	14.00	21.00					14.00			7.00			0.47	0.23		0.47	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2758	008	0	1	02	01	H2758_008_0	6	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								42.00	77.00	112.00					35.00	70.00	105.00											42.00	77.00	112.00				35.00	70.00	105.00					42.00			35.00			1.40	1.17		1.40	1.17	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2758	008	0	1	02	01	H2758_008_0	6	Non-Preferred Brand	4	110000	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								92.00	177.00	262.00					85.00	170.00	255.00											92.00	177.00	262.00				85.00	170.00	255.00					92.00			85.00			3.07	2.83		3.07	2.83	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2758	008	0	1	02	01	H2758_008_0	6	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											999.00	33						999.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2758	008	0	1	02	01	H2758_008_0	6	Select Care Drugs	4	010000	1	2	6	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								7.00	7.00	0.00					7.00	7.00	0.00											7.00	7.00	0.00				7.00	7.00	0.00					7.00			7.00			0.23	0.23		0.23	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H2758	008	0	1	02	01	H2758_008_0	6	Select Care Drugs	4	010000	1	2	6	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								7.00	7.00	0.00					7.00	7.00	0.00											7.00	7.00	0.00				7.00	7.00	0.00					7.00			7.00			0.23	0.23		0.23	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H2773	003	0	1	01	01	H2773_003_0	12	Preferred Generic	4	001000	1	2	1	1	110		01	110		1	31		90				1	2	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2773	003	0	1	01	01	H2773_003_0	12	Preferred Generic	4	001000	1	2	1	3	110		01	110		1	31		90				1	2	31		90				31		31	4.00		12.00																			4.00		8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2773	003	0	1	01	01	H2773_003_0	12	Generic	4	010000	1	2	2	1	110		01	110		1	31		90				1	2	31		90				31		31	10.00		30.00																			10.00		20.00																10.00				10.00		0.32			0.32			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2773	003	0	1	01	01	H2773_003_0	12	Preferred Brand	4	000101	1	2	3	1	110		01	110		1	31		90				1	2	31		90				31		31	30.00		90.00																			30.00		90.00																30.00				30.00		.97			.97			.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2773	003	0	1	01	01	H2773_003_0	12	Non-Preferred Brand	4	100100	3	1	4	1	110		01	110		1	31		90				1	2	31		90				31		31				23.32	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2773	003	0	1	01	01	H2773_003_0	12	Specialty Tier	4	110000	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												
H2773	017	0	1	01	01	H2773_017_0	13	Preferred Generic	4	001000	1	2	1	1	110		01	110		1	31		90				1	2	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2773	017	0	1	01	01	H2773_017_0	13	Preferred Generic	4	001000	1	2	1	3	110		01	110		1	31		90				1	2	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2773	017	0	1	01	01	H2773_017_0	13	Generic	4	010000	1	2	2	1	110		01	110		1	31		90				1	2	31		90				31		31	10.00		30.00																			10.00		20.00																10.00				10.00		0.32			0.32			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2773	017	0	1	01	01	H2773_017_0	13	Preferred Brand	4	000101	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 Brand, Specialty Tier												
H2773	017	0	1	01	01	H2773_017_0	13	Non-Preferred Brand	4	100100	3	1	4	1	110		01	110		1	31		90				1	2	31		90				31		31				37.20	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2773	017	0	1	01	01	H2773_017_0	13	Specialty Tier	4	110000	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												
H2773	018	0	1	01	01	H2773_018_0	12	Preferred Generic	4	001000	1	2	1	1	110		01	110		1	31		90				1	2	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2773	018	0	1	01	01	H2773_018_0	12	Preferred Generic	4	001000	1	2	1	3	110		01	110		1	31		90				1	2	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2773	018	0	1	01	01	H2773_018_0	12	Generic	4	010000	1	2	2	1	110		01	110		1	31		90				1	2	31		90				31		31	10.00		30.00																			10.00		20.00																10.00				10.00		0.32			0.32			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2773	018	0	1	01	01	H2773_018_0	12	Preferred Brand	4	000101	1	2	3	1	110		01	110		1	31		90				1	2	31		90				31		31	30.00		90.00																			30.00		90.00																30.00				30.00		.97			.97			.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2773	018	0	1	01	01	H2773_018_0	12	Non-Preferred Brand	4	100100	3	1	4	1	110		01	110		1	31		90				1	2	31		90				31		31				43.62	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2773	018	0	1	01	01	H2773_018_0	12	Specialty Tier	4	110000	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												
H2773	019	0	1	01	01	H2773_019_0	11	Preferred Generic	4	001000	1	2	1	1	110		01	110		1	31		90				1	2	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		.00			.00			.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2773	019	0	1	01	01	H2773_019_0	11	Preferred Generic	4	001000	1	2	1	3	110		01	110		1	31		90				1	2	31		90				31		31	4.00		12.00																			4.00		8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2773	019	0	1	01	01	H2773_019_0	11	Generic	4	010000	1	2	2	1	110		01	110		1	31		90				1	2	31		90				31		31	15.00		45.00																			15.00		30.00																15.00				15.00		.48			.48			.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2773	019	0	1	01	01	H2773_019_0	11	Preferred Brand	4	000101	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 Brand, Specialty Tier												
H2773	019	0	1	01	01	H2773_019_0	11	Non-Preferred Brand	4	100100	3	1	4	1	110		01	110		1	31		90				1	2	31		90				31		31				27.72	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2773	019	0	1	01	01	H2773_019_0	11	Specialty Tier	4	110000	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												
H2773	020	0	1	01	01	H2773_020_0	11	Preferred Generic	4	001000	1	2	1	1	110		01	110		1	31		90				1	2	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2773	020	0	1	01	01	H2773_020_0	11	Preferred Generic	4	001000	1	2	1	3	110		01	110		1	31		90				1	2	31		90				31		31	4.00		12.00																			4.00		8.00																4.00				4.00		0.13			.13			.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2773	020	0	1	01	01	H2773_020_0	11	Generic	4	010000	1	2	2	1	110		01	110		1	31		90				1	2	31		90				31		31	10.00		30.00																			10.00		20.00																10.00				10.00		0.32			0.32			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2773	020	0	1	01	01	H2773_020_0	11	Preferred Brand	4	000101	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 Brand, Specialty Tier												
H2773	020	0	1	01	01	H2773_020_0	11	Non-Preferred Brand	4	100100	3	1	4	1	110		01	110		1	31		90				1	2	31		90				31		31				39.12	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2773	020	0	1	01	01	H2773_020_0	11	Specialty Tier	4	110000	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												
H2773	022	0	1	01	01	H2773_022_0	9	Preferred Generic	4	001000	1	2	1	1	110		01	110		1	31		90				1	2	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2773	022	0	1	01	01	H2773_022_0	9	Preferred Generic	4	001000	1	2	1	3	110		01	110		1	31		90				1	2	31		90				31		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2773	022	0	1	01	01	H2773_022_0	9	Generic	4	010000	1	2	2	1	110		01	110		1	31		90				1	2	31		90				31		31	10.00		30.00																			10.00		20.00																10.00				10.00		0.32			0.32			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2773	022	0	1	01	01	H2773_022_0	9	Preferred Brand	4	000101	1	2	3	1	110		01	110		1	31		90				1	2	31		90				31		31	25.00		75.00																			25.00		75.00																25.00				25.00		.81			.81			.81	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2773	022	0	1	01	01	H2773_022_0	9	Non-Preferred Brand	4	100100	3	1	4	1	110		01	110		1	31		90				1	2	31		90				31		31				39.81	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2773	022	0	1	01	01	H2773_022_0	9	Specialty Tier	4	110000	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												
H2775	082	0	1	04	01	H2775_082_0	14	Preferred Generic	4	001001	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		34								5.00		12.50					0.00		0.00											5.00		12.50				0.00		0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	082	0	1	04	01	H2775_082_0	14	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		34								10.00		25.00					5.00		12.50											10.00		25.00				5.00		5.00				10.00				10.00			0.33	0.17		0.33	0.17	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	082	0	1	04	01	H2775_082_0	14	Preferred Brand	4	000101	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		34								45.00		112.50					35.00		87.50											45.00		112.50				35.00		70.00				45.00				45.00			1.50	1.17		1.50	1.17	1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	082	0	1	04	01	H2775_082_0	14	Non-Preferred Drug	4	100100	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		34								85.00		212.50					75.00		187.50											85.00		212.50				75.00		150.00				85.00				85.00			2.83	2.50		2.83	2.50	2.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	082	0	1	04	01	H2775_082_0	14	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		34											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	083	0	1	04	01	H2775_083_0	14	Preferred Generic	4	001001	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		34								5.00		12.50					0.00		0.00											5.00		12.50				0.00		0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	083	0	1	04	01	H2775_083_0	14	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		34								10.00		25.00					5.00		12.50											10.00		25.00				5.00		5.00				10.00				10.00			0.33	0.17		0.33	0.17	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	083	0	1	04	01	H2775_083_0	14	Preferred Brand	4	000101	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		34								45.00		112.50					35.00		87.50											45.00		112.50				35.00		70.00				45.00				45.00			1.50	1.17		1.50	1.17	1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	083	0	1	04	01	H2775_083_0	14	Non-Preferred Drug	4	100100	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		34								85.00		212.50					75.00		187.50											85.00		212.50				75.00		150.00				85.00				85.00			2.83	2.50		2.83	2.50	2.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	083	0	1	04	01	H2775_083_0	14	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		34											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	088	0	1	04	01	H2775_088_0	15	Preferred Generic	4	001001	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		34								7.00		17.50					2.00		5.00											7.00		17.50				2.00		2.00				7.00				7.00			0.23	0.07		0.23	0.07	0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	088	0	1	04	01	H2775_088_0	15	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		34								12.00		30.00					7.00		17.50											12.00		30.00				7.00		7.00				12.00				12.00			0.40	0.23		0.40	0.23	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	088	0	1	04	01	H2775_088_0	15	Preferred Brand	4	000101	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		34								47.00		117.50					37.00		92.50											47.00		117.50				37.00		74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	088	0	1	04	01	H2775_088_0	15	Non-Preferred Drug	4	100100	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		34								100.00		250.00					90.00		225.00											100.00		250.00				90.00		180.00				100.00				100.00			3.33	3.00		3.33	3.00	2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	088	0	1	04	01	H2775_088_0	15	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		34											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	089	0	1	04	01	H2775_089_0	15	Preferred Generic	4	001001	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		34								7.00		17.50					2.00		5.00											7.00		17.50				2.00		2.00				7.00				7.00			0.23	0.07		0.23	0.07	0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	089	0	1	04	01	H2775_089_0	15	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		34								12.00		30.00					7.00		17.50											12.00		30.00				7.00		7.00				12.00				12.00			0.40	0.23		0.40	0.23	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	089	0	1	04	01	H2775_089_0	15	Preferred Brand	4	000101	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		34								47.00		117.50					37.00		92.50											47.00		117.50				37.00		74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	089	0	1	04	01	H2775_089_0	15	Non-Preferred Drug	4	100100	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		34								100.00		250.00					90.00		225.00											100.00		250.00				90.00		180.00				100.00				100.00			3.33	3.00		3.33	3.00	2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	089	0	1	04	01	H2775_089_0	15	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		34											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	099	0	1	04	01	H2775_099_0	14	Preferred Generic	4	001001	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		34								5.00		12.50					0.00		0.00											5.00		12.50				0.00		0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	099	0	1	04	01	H2775_099_0	14	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		34								10.00		25.00					5.00		12.50											10.00		25.00				5.00		5.00				10.00				10.00			0.33	0.17		0.33	0.17	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	099	0	1	04	01	H2775_099_0	14	Preferred Brand	4	000101	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		34								45.00		112.50					35.00		87.50											45.00		112.50				35.00		70.00				45.00				45.00			1.50	1.17		1.50	1.17	1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	099	0	1	04	01	H2775_099_0	14	Non-Preferred Drug	4	100100	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		34								85.00		212.50					75.00		187.50											85.00		212.50				75.00		150.00				85.00				85.00			2.83	2.50		2.83	2.50	2.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	099	0	1	04	01	H2775_099_0	14	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		34											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	100	0	1	04	01	H2775_100_0	14	Preferred Generic	4	001001	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		34								7.00		17.50					2.00		5.00											7.00		17.50				2.00		2.00				7.00				7.00			0.23	0.07		0.23	0.07	0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	100	0	1	04	01	H2775_100_0	14	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		34								12.00		30.00					7.00		17.50											12.00		30.00				7.00		7.00				12.00				12.00			0.40	0.23		0.40	0.23	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	100	0	1	04	01	H2775_100_0	14	Preferred Brand	4	000101	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		34								47.00		117.50					37.00		92.50											47.00		117.50				37.00		74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	100	0	1	04	01	H2775_100_0	14	Non-Preferred Drug	4	100100	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		34								100.00		250.00					90.00		225.00											100.00		250.00				90.00		180.00				100.00				100.00			3.33	3.00		3.33	3.00	2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2775	100	0	1	04	01	H2775_100_0	14	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		34											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	001	0	1	01	01	H2802_001_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	001	0	1	01	01	H2802_001_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	001	0	1	01	01	H2802_001_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		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	001	0	1	01	01	H2802_001_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		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	001	0	1	01	01	H2802_001_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				687.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	007	0	1	01	01	H2802_007_0	4	Preferred Generic	3	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	007	0	1	01	01	H2802_007_0	4	Generic	3	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	007	0	1	01	01	H2802_007_0	4	Preferred Brand	3	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	007	0	1	01	01	H2802_007_0	4	Non-Preferred Drug	3	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	007	0	1	01	01	H2802_007_0	4	Specialty Tier	3	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				656.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	008	0	1	01	01	H2802_008_0	4	Preferred Generic	3	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	008	0	1	01	01	H2802_008_0	4	Generic	3	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	008	0	1	01	01	H2802_008_0	4	Preferred Brand	3	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	008	0	1	01	01	H2802_008_0	4	Non-Preferred Drug	3	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	008	0	1	01	01	H2802_008_0	4	Specialty Tier	3	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				684.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	010	0	1	01	01	H2802_010_0	4	Preferred Generic	3	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	010	0	1	01	01	H2802_010_0	4	Generic	3	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	010	0	1	01	01	H2802_010_0	4	Preferred Brand	3	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	010	0	1	01	01	H2802_010_0	4	Non-Preferred Drug	3	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	010	0	1	01	01	H2802_010_0	4	Specialty Tier	3	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				643.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	012	0	1	01	01	H2802_012_0	4	Preferred Generic	3	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	012	0	1	01	01	H2802_012_0	4	Generic	3	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	012	0	1	01	01	H2802_012_0	4	Preferred Brand	3	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	012	0	1	01	01	H2802_012_0	4	Non-Preferred Drug	3	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	012	0	1	01	01	H2802_012_0	4	Specialty Tier	3	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				811.00	30		30																										30						30			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	013	0	1	01	01	H2802_013_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	013	0	1	01	01	H2802_013_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	013	0	1	01	01	H2802_013_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	013	0	1	01	01	H2802_013_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	013	0	1	01	01	H2802_013_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				857.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	014	0	1	01	01	H2802_014_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	014	0	1	01	01	H2802_014_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	014	0	1	01	01	H2802_014_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	014	0	1	01	01	H2802_014_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	014	0	1	01	01	H2802_014_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				719.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	015	0	1	01	01	H2802_015_0	5	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	015	0	1	01	01	H2802_015_0	5	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	015	0	1	01	01	H2802_015_0	5	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	015	0	1	01	01	H2802_015_0	5	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	015	0	1	01	01	H2802_015_0	5	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				739.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	016	0	1	01	01	H2802_016_0	4	Preferred Generic	3	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	016	0	1	01	01	H2802_016_0	4	Generic	3	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	016	0	1	01	01	H2802_016_0	4	Preferred Brand	3	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	016	0	1	01	01	H2802_016_0	4	Non-Preferred Drug	3	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		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	016	0	1	01	01	H2802_016_0	4	Specialty Tier	3	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				811.00	31		31																										31						31			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	017	0	1	01	01	H2802_017_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	017	0	1	01	01	H2802_017_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	017	0	1	01	01	H2802_017_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	017	0	1	01	01	H2802_017_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	017	0	1	01	01	H2802_017_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				857.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	018	0	1	01	01	H2802_018_0	4	Preferred Generic	3	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	018	0	1	01	01	H2802_018_0	4	Generic	3	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	018	0	1	01	01	H2802_018_0	4	Preferred Brand	3	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	018	0	1	01	01	H2802_018_0	4	Non-Preferred Drug	3	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	018	0	1	01	01	H2802_018_0	4	Specialty Tier	3	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				654.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	019	0	1	01	01	H2802_019_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	019	0	1	01	01	H2802_019_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	019	0	1	01	01	H2802_019_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	019	0	1	01	01	H2802_019_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	019	0	1	01	01	H2802_019_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				739.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	020	0	1	01	01	H2802_020_0	4	Preferred Generic	3	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	020	0	1	01	01	H2802_020_0	4	Generic	3	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	020	0	1	01	01	H2802_020_0	4	Preferred Brand	3	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	020	0	1	01	01	H2802_020_0	4	Non-Preferred Drug	3	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	020	0	1	01	01	H2802_020_0	4	Specialty Tier	3	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				631.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	021	0	1	01	01	H2802_021_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	021	0	1	01	01	H2802_021_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	021	0	1	01	01	H2802_021_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	021	0	1	01	01	H2802_021_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	021	0	1	01	01	H2802_021_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				719.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	022	0	1	01	01	H2802_022_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	022	0	1	01	01	H2802_022_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	022	0	1	01	01	H2802_022_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		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	022	0	1	01	01	H2802_022_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		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	022	0	1	01	01	H2802_022_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				687.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	023	0	1	01	01	H2802_023_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	023	0	1	01	01	H2802_023_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		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	023	0	1	01	01	H2802_023_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		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	023	0	1	01	01	H2802_023_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		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	023	0	1	01	01	H2802_023_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				862.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	024	0	1	01	01	H2802_024_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	024	0	1	01	01	H2802_024_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		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	01	01	H2802_024_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	024	0	1	01	01	H2802_024_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	024	0	1	01	01	H2802_024_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				859.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	025	0	1	01	01	H2802_025_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	025	0	1	01	01	H2802_025_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	025	0	1	01	01	H2802_025_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	025	0	1	01	01	H2802_025_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	025	0	1	01	01	H2802_025_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				775.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	026	0	1	01	01	H2802_026_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	026	0	1	01	01	H2802_026_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	026	0	1	01	01	H2802_026_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	026	0	1	01	01	H2802_026_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	026	0	1	01	01	H2802_026_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				871.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	028	0	1	01	01	H2802_028_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	028	0	1	01	01	H2802_028_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		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	028	0	1	01	01	H2802_028_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	028	0	1	01	01	H2802_028_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	028	0	1	01	01	H2802_028_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				770.00	30		30																										30						30			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	029	0	1	01	01	H2802_029_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	029	0	1	01	01	H2802_029_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	029	0	1	01	01	H2802_029_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	029	0	1	01	01	H2802_029_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	029	0	1	01	01	H2802_029_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				986.00	30		30																										30						30			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	030	0	1	01	01	H2802_030_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	030	0	1	01	01	H2802_030_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	030	0	1	01	01	H2802_030_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	030	0	1	01	01	H2802_030_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	030	0	1	01	01	H2802_030_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				1003.00	30		30																										30						30			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	031	0	1	01	01	H2802_031_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	031	0	1	01	01	H2802_031_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		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	031	0	1	01	01	H2802_031_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	031	0	1	01	01	H2802_031_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	031	0	1	01	01	H2802_031_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				984.00	30		30																										30						30			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	032	0	1	01	01	H2802_032_0	4	Preferred Generic	3	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	032	0	1	01	01	H2802_032_0	4	Generic	3	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		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	032	0	1	01	01	H2802_032_0	4	Preferred Brand	3	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	032	0	1	01	01	H2802_032_0	4	Non-Preferred Drug	3	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	032	0	1	01	01	H2802_032_0	4	Specialty Tier	3	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				697.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	033	0	1	01	01	H2802_033_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	033	0	1	01	01	H2802_033_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	033	0	1	01	01	H2802_033_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	033	0	1	01	01	H2802_033_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	033	0	1	01	01	H2802_033_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				814.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	034	0	1	01	01	H2802_034_0	4	Preferred Generic	3	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	034	0	1	01	01	H2802_034_0	4	Generic	3	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	034	0	1	01	01	H2802_034_0	4	Preferred Brand	3	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	034	0	1	01	01	H2802_034_0	4	Non-Preferred Drug	3	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	034	0	1	01	01	H2802_034_0	4	Specialty Tier	3	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				693.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	035	0	1	01	01	H2802_035_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	035	0	1	01	01	H2802_035_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	035	0	1	01	01	H2802_035_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	035	0	1	01	01	H2802_035_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	035	0	1	01	01	H2802_035_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				814.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	036	0	1	01	01	H2802_036_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	036	0	1	01	01	H2802_036_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	036	0	1	01	01	H2802_036_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	036	0	1	01	01	H2802_036_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	036	0	1	01	01	H2802_036_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				765.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	037	0	1	01	01	H2802_037_0	4	Preferred Generic	3	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	037	0	1	01	01	H2802_037_0	4	Generic	3	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	037	0	1	01	01	H2802_037_0	4	Preferred Brand	3	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		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	037	0	1	01	01	H2802_037_0	4	Non-Preferred Drug	3	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		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	037	0	1	01	01	H2802_037_0	4	Specialty Tier	3	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				763.00	30		30																										30						30			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	038	0	1	01	01	H2802_038_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	038	0	1	01	01	H2802_038_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	038	0	1	01	01	H2802_038_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		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	038	0	1	01	01	H2802_038_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		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	038	0	1	01	01	H2802_038_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				832.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	039	0	1	01	01	H2802_039_0	4	Preferred Generic	3	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	039	0	1	01	01	H2802_039_0	4	Generic	3	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	039	0	1	01	01	H2802_039_0	4	Preferred Brand	3	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		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	039	0	1	01	01	H2802_039_0	4	Non-Preferred Drug	3	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		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	039	0	1	01	01	H2802_039_0	4	Specialty Tier	3	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				763.00	30		30																										30						30			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	040	0	1	01	01	H2802_040_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	040	0	1	01	01	H2802_040_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	040	0	1	01	01	H2802_040_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		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	040	0	1	01	01	H2802_040_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		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	040	0	1	01	01	H2802_040_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				832.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	041	0	1	01	01	H2802_041_0	8	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	041	0	1	01	01	H2802_041_0	8	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	041	0	1	01	01	H2802_041_0	8	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	041	0	1	01	01	H2802_041_0	8	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	041	0	1	01	01	H2802_041_0	8	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				824.00	31		31																										31						31			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	042	0	1	01	01	H2802_042_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	042	0	1	01	01	H2802_042_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	042	0	1	01	01	H2802_042_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	042	0	1	01	01	H2802_042_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	042	0	1	01	01	H2802_042_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				835.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	045	0	1	01	01	H2802_045_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	045	0	1	01	01	H2802_045_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	045	0	1	01	01	H2802_045_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		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	045	0	1	01	01	H2802_045_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2802	045	0	1	01	01	H2802_045_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				751.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2816	013	0	1	09	04	H2816_013_0	14	Preferred Generic	4	001001	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		34								5.00		12.50					0.00		0.00											5.00		12.50				0.00		0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2816	013	0	1	09	04	H2816_013_0	14	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		34								10.00		25.00					5.00		12.50											10.00		25.00				5.00		5.00				10.00				10.00			0.33	0.17		0.33	0.17	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2816	013	0	1	09	04	H2816_013_0	14	Preferred Brand	4	000101	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		34								45.00		112.50					35.00		87.50											45.00		112.50				35.00		70.00				45.00				45.00			1.50	1.17		1.50	1.17	1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2816	013	0	1	09	04	H2816_013_0	14	Non-Preferred Drug	4	100100	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		34								85.00		212.50					75.00		187.50											85.00		212.50				75.00		150.00				85.00				85.00			2.83	2.50		2.83	2.50	2.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2816	013	0	1	09	04	H2816_013_0	14	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		34											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2816	019	0	1	09	04	H2816_019_0	15	Preferred Generic	4	001001	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		34								7.00		17.50					2.00		5.00											7.00		17.50				2.00		2.00				7.00				7.00			0.23	0.07		0.23	0.07	0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2816	019	0	1	09	04	H2816_019_0	15	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		34								12.00		30.00					7.00		17.50											12.00		30.00				7.00		7.00				12.00				12.00			0.40	0.23		0.40	0.23	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2816	019	0	1	09	04	H2816_019_0	15	Preferred Brand	4	000101	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		34								47.00		117.50					37.00		92.50											47.00		117.50				37.00		74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2816	019	0	1	09	04	H2816_019_0	15	Non-Preferred Drug	4	100100	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		34								100.00		250.00					90.00		225.00											100.00		250.00				90.00		180.00				100.00				100.00			3.33	3.00		3.33	3.00	2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2816	019	0	1	09	04	H2816_019_0	15	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		34											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2879	001	0	1	01	01	H2879_001_0	8	Preferred Generic	3	001001	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	8	Generic	3	010001	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												
H2879	001	0	1	01	01	H2879_001_0	8	Preferred Brand	3	000101	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	8	Non-Preferred Drug	3	100100	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				82.45	32	32	32																		32	32	32															32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2879	001	0	1	01	01	H2879_001_0	8	Specialty Tier	3	010010	1	1	5	1	010		01	010		1	31								31						31		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2906	005	0	1	04	01	H2906_005_0	18	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					6.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2906	005	0	1	04	01	H2906_005_0	18	Preferred Generic	4	001000	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					6.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2906	005	0	1	04	01	H2906_005_0	18	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	12.00		30.00																					24.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2906	005	0	1	04	01	H2906_005_0	18	Generic	4	010000	1	2	2	3	110		01	100		1	30		90				1	2			90				30		31	12.00		30.00																					24.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2906	005	0	1	04	01	H2906_005_0	18	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	45.00		112.50																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2906	005	0	1	04	01	H2906_005_0	18	Non-Preferred Brand	4	100000	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	80.00		200.00																					160.00																80.00				80.00		2.67						2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2906	005	0	1	04	01	H2906_005_0	18	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31				264.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2906	006	0	1	04	01	H2906_006_0	12	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	6.00		15.00																					12.00																6.00				6.00		0.20						0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2906	006	0	1	04	01	H2906_006_0	12	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	14.00		35.00																					28.00																14.00				14.00		0.47						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2906	006	0	1	04	01	H2906_006_0	12	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	45.00		112.50																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2906	006	0	1	04	01	H2906_006_0	12	Non-Preferred Brand	4	100000	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	95.00		237.50																					190.00																95.00				95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2906	006	0	1	04	01	H2906_006_0	12	Specialty Tier	4	000010	1	1	5	1	010		01	010		1	30								30						30		31				264.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2906	007	0	1	04	01	H2906_007_0	12	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	8.00		20.00																					16.00																8.00				8.00		0.27						0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2906	007	0	1	04	01	H2906_007_0	12	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	16.00		40.00																					32.00																16.00				16.00		0.53						0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2906	007	0	1	04	01	H2906_007_0	12	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	45.00		112.50																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2906	007	0	1	04	01	H2906_007_0	12	Non-Preferred Brand	4	100000	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	95.00		237.50																					190.00																95.00				95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2906	007	0	1	04	01	H2906_007_0	12	Specialty Tier	4	000001	1	1	5	1	010		01	010		1	30								30						30		31				264.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2931	002	0	1	01	01	H2931_002_0	6	Preferred Generic	4	001000	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						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2931	002	0	1	01	01	H2931_002_0	6	Preferred Generic	4	001000	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						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H2931	002	0	1	01	01	H2931_002_0	6	Generic	4	010000	1	2	2	1	110		01		100	1	30		100				1	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												
H2931	002	0	1	01	01	H2931_002_0	6	Generic	4	010000	1	2	2	3	110		01		100	1	30		100				1	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		
H2931	002	0	1	01	01	H2931_002_0	6	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		100				1	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2931	002	0	1	01	01	H2931_002_0	6	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		100				1	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2931	002	0	1	01	01	H2931_002_0	6	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		100				1	2						100	30		31				1184.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2931	004	0	1	01	01	H2931_004_0	5	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		100				1	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												
H2931	004	0	1	01	01	H2931_004_0	5	Generic	4	010000	1	2	2	1	110		01		100	1	30		100				1	2						100	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2931	004	0	1	01	01	H2931_004_0	5	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		100				1	2						100	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2931	004	0	1	01	01	H2931_004_0	5	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		100				1	2						100	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2931	004	0	1	01	01	H2931_004_0	5	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		100				1	2						100	30		31				726.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2944	004	0	1	09	04	H2944_004_0	3	Preferred Generic	3	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								8.00		24.00					3.00		9.00											8.00		24.00				3.00		0.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2944	004	0	1	09	04	H2944_004_0	3	Generic	3	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2944	004	0	1	09	04	H2944_004_0	3	Preferred Brand	3	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2944	004	0	1	09	04	H2944_004_0	3	Non-Preferred Drug	3	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2944	004	0	1	09	04	H2944_004_0	3	Specialty Tier	3	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2944	013	0	1	09	04	H2944_013_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2944	013	0	1	09	04	H2944_013_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2944	013	0	1	09	04	H2944_013_0	3	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								19.00		57.00					14.00		42.00											19.00		57.00				14.00		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												
H2944	013	0	1	09	04	H2944_013_0	3	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								19.00		57.00					14.00		42.00											19.00		57.00				14.00		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										2	3	
H2944	013	0	1	09	04	H2944_013_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2944	013	0	1	09	04	H2944_013_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2944	013	0	1	09	04	H2944_013_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2944	013	0	1	09	04	H2944_013_0	3	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2944	013	0	1	09	04	H2944_013_0	3	Specialty Tier	4	010010	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												
H2944	013	0	1	09	04	H2944_013_0	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2944	114	0	1	09	04	H2944_114_0	3	Preferred Generic	3	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								9.00		27.00					4.00		12.00											9.00		27.00				4.00		0.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2944	114	0	1	09	04	H2944_114_0	3	Generic	3	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2944	114	0	1	09	04	H2944_114_0	3	Preferred Brand	3	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2944	114	0	1	09	04	H2944_114_0	3	Non-Preferred Drug	3	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2944	114	0	1	09	04	H2944_114_0	3	Specialty Tier	3	010010	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2944	124	0	1	09	04	H2944_124_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2944	124	0	1	09	04	H2944_124_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2944	124	0	1	09	04	H2944_124_0	3	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2944	124	0	1	09	04	H2944_124_0	3	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2944	124	0	1	09	04	H2944_124_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2944	124	0	1	09	04	H2944_124_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2944	124	0	1	09	04	H2944_124_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2944	124	0	1	09	04	H2944_124_0	3	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2944	124	0	1	09	04	H2944_124_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2944	124	0	1	09	04	H2944_124_0	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2944	127	0	1	09	04	H2944_127_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2944	127	0	1	09	04	H2944_127_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2944	127	0	1	09	04	H2944_127_0	3	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2944	127	0	1	09	04	H2944_127_0	3	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2944	127	0	1	09	04	H2944_127_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2944	127	0	1	09	04	H2944_127_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2944	127	0	1	09	04	H2944_127_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2944	127	0	1	09	04	H2944_127_0	3	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2944	127	0	1	09	04	H2944_127_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2944	127	0	1	09	04	H2944_127_0	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2949	012	0	1	01	01	H2949_012_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								7.00		21.00					2.00		6.00											7.00		21.00				2.00		0.00				7.00				7.00			0.23	0.07		0.23	0.07	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2949	012	0	1	01	01	H2949_012_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								7.00		21.00					2.00		6.00											7.00		21.00				2.00		0.00				7.00				7.00			0.23	0.07		0.23	0.07	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2949	012	0	1	01	01	H2949_012_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								13.00		39.00					8.00		24.00											13.00		39.00				8.00		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												
H2949	012	0	1	01	01	H2949_012_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								13.00		39.00					8.00		24.00											13.00		39.00				8.00		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										2	3	
H2949	012	0	1	01	01	H2949_012_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2949	012	0	1	01	01	H2949_012_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2949	012	0	1	01	01	H2949_012_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2949	012	0	1	01	01	H2949_012_0	4	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2949	012	0	1	01	01	H2949_012_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2949	012	0	1	01	01	H2949_012_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2949	013	0	1	01	01	H2949_013_0	6	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2949	013	0	1	01	01	H2949_013_0	6	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	
H2949	013	0	1	01	01	H2949_013_0	6	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								11.00		33.00					6.00		18.00											11.00		33.00				6.00		0.00				11.00				11.00			0.37	0.20		0.37	0.20	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2949	013	0	1	01	01	H2949_013_0	6	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								11.00		33.00					6.00		18.00											11.00		33.00				6.00		0.00				11.00				11.00			0.37	0.20		0.37	0.20	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2949	013	0	1	01	01	H2949_013_0	6	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								45.00		135.00					40.00		120.00											45.00		135.00				40.00		110.00				45.00				45.00			1.50	1.33		1.50	1.33	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2949	013	0	1	01	01	H2949_013_0	6	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								45.00		135.00					40.00		120.00											45.00		135.00				40.00		110.00				45.00				45.00			1.50	1.33		1.50	1.33	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2949	013	0	1	01	01	H2949_013_0	6	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								85.00		255.00					80.00		240.00											85.00		255.00				80.00		230.00				85.00				85.00			2.83	2.67		2.83	2.67	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2949	013	0	1	01	01	H2949_013_0	6	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								85.00		255.00					80.00		240.00											85.00		255.00				80.00		230.00				85.00				85.00			2.83	2.67		2.83	2.67	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2949	013	0	1	01	01	H2949_013_0	6	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2949	013	0	1	01	01	H2949_013_0	6	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	2	
H2949	014	0	1	01	01	H2949_014_0	5	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								6.00		18.00					1.00		3.00											6.00		18.00				1.00		0.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2949	014	0	1	01	01	H2949_014_0	5	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								6.00		18.00					1.00		3.00											6.00		18.00				1.00		0.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2949	014	0	1	01	01	H2949_014_0	5	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								7.00		21.00					2.00		6.00											7.00		21.00				2.00		0.00				7.00				7.00			0.23	0.07		0.23	0.07	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2949	014	0	1	01	01	H2949_014_0	5	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								7.00		21.00					2.00		6.00											7.00		21.00				2.00		0.00				7.00				7.00			0.23	0.07		0.23	0.07	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2949	014	0	1	01	01	H2949_014_0	5	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								45.00		135.00					40.00		120.00											45.00		135.00				40.00		110.00				45.00				45.00			1.50	1.33		1.50	1.33	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2949	014	0	1	01	01	H2949_014_0	5	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								45.00		135.00					40.00		120.00											45.00		135.00				40.00		110.00				45.00				45.00			1.50	1.33		1.50	1.33	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2949	014	0	1	01	01	H2949_014_0	5	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								85.00		255.00					80.00		240.00											85.00		255.00				80.00		230.00				85.00				85.00			2.83	2.67		2.83	2.67	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2949	014	0	1	01	01	H2949_014_0	5	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								85.00		255.00					80.00		240.00											85.00		255.00				80.00		230.00				85.00				85.00			2.83	2.67		2.83	2.67	2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2949	014	0	1	01	01	H2949_014_0	5	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2949	014	0	1	01	01	H2949_014_0	5	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H2949	018	0	1	01	01	H2949_018_0	7	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2949	018	0	1	01	01	H2949_018_0	7	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								11.00		33.00					6.00		18.00											11.00		33.00				6.00		0.00				11.00				11.00			0.37	0.20		0.37	0.20	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2949	018	0	1	01	01	H2949_018_0	7	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2949	018	0	1	01	01	H2949_018_0	7	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2949	018	0	1	01	01	H2949_018_0	7	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H2960	004	0	1	01	01	H2960_004_0	12	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	5.00		12.50																					10.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2960	004	0	1	01	01	H2960_004_0	12	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	14.00		35.00																					28.00																14.00				14.00		0.47						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2960	004	0	1	01	01	H2960_004_0	12	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	45.00		112.50																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2960	004	0	1	01	01	H2960_004_0	12	Non-Preferred Brand	4	100000	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	95.00		237.50																					190.00																95.00				95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2960	004	0	1	01	01	H2960_004_0	12	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31				264.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2960	012	0	1	01	01	H2960_012_0	12	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	6.00		15.00																					12.00																6.00				6.00		0.20						0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2960	012	0	1	01	01	H2960_012_0	12	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	16.00		40.00																					32.00																16.00				16.00		0.53						0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2960	012	0	1	01	01	H2960_012_0	12	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	45.00		112.50																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2960	012	0	1	01	01	H2960_012_0	12	Non-Preferred Brand	4	100000	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	95.00		237.50																					190.00																95.00				95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2960	012	0	1	01	01	H2960_012_0	12	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31				264.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2960	018	0	1	01	01	H2960_018_0	11	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					6.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2960	018	0	1	01	01	H2960_018_0	11	Preferred Generic	4	001000	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					6.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2960	018	0	1	01	01	H2960_018_0	11	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	12.00		30.00																					24.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2960	018	0	1	01	01	H2960_018_0	11	Generic	4	010000	1	2	2	3	110		01	100		1	30		90				1	2			90				30		31	12.00		30.00																					24.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2960	018	0	1	01	01	H2960_018_0	11	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	45.00		112.50																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2960	018	0	1	01	01	H2960_018_0	11	Non-Preferred Brand	4	100000	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	95.00		237.50																					190.00																95.00				95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2960	018	0	1	01	01	H2960_018_0	11	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31				264.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2962	001	0	1	01	01	H2962_001_0	9	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2962	001	0	1	01	01	H2962_001_0	9	Preferred Generic	4	001000	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2962	001	0	1	01	01	H2962_001_0	9	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	15.00		45.00																					30.00																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2962	001	0	1	01	01	H2962_001_0	9	Generic	4	010000	1	2	2	3	110		01	100		1	30		90				1	2			90				30		31	15.00		45.00																					30.00																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2962	001	0	1	01	01	H2962_001_0	9	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	35.00		105.00																					70.00																35.00				35.00		1.17						1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2962	001	0	1	01	01	H2962_001_0	9	Non-Preferred Brand	4	100000	3	2	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2962	001	0	1	01	01	H2962_001_0	9	Specialty Tier	4	010010	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31				826.39	33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2962	002	0	1	01	01	H2962_002_0	10	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2962	002	0	1	01	01	H2962_002_0	10	Preferred Generic	4	001000	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2962	002	0	1	01	01	H2962_002_0	10	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	10.00		30.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2962	002	0	1	01	01	H2962_002_0	10	Generic	4	010000	1	2	2	3	110		01	100		1	30		90				1	2			90				30		31	10.00		30.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2962	002	0	1	01	01	H2962_002_0	10	Preferred Brand	4	000001	1	2	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2962	002	0	1	01	01	H2962_002_0	10	Non-Preferred Brand	4	100000	3	2	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2962	002	0	1	01	01	H2962_002_0	10	Specialty Tier	4	010010	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31				781.28	33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2962	003	0	1	01	01	H2962_003_0	10	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2962	003	0	1	01	01	H2962_003_0	10	Preferred Generic	4	001000	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2962	003	0	1	01	01	H2962_003_0	10	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	15.00		45.00																					30.00																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2962	003	0	1	01	01	H2962_003_0	10	Generic	4	010000	1	2	2	3	110		01	100		1	30		90				1	2			90				30		31	15.00		45.00																					30.00																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2962	003	0	1	01	01	H2962_003_0	10	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	35.00		105.00																					70.00																35.00				35.00		1.17						1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2962	003	0	1	01	01	H2962_003_0	10	Non-Preferred Brand	4	100000	3	2	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2962	003	0	1	01	01	H2962_003_0	10	Specialty Tier	4	010010	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31				734.77	33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2962	004	0	1	01	01	H2962_004_0	10	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2962	004	0	1	01	01	H2962_004_0	10	Preferred Generic	4	001000	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2962	004	0	1	01	01	H2962_004_0	10	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	10.00		30.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2962	004	0	1	01	01	H2962_004_0	10	Generic	4	010000	1	2	2	3	110		01	100		1	30		90				1	2			90				30		31	10.00		30.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2962	004	0	1	01	01	H2962_004_0	10	Preferred Brand	4	000001	1	2	3	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2962	004	0	1	01	01	H2962_004_0	10	Non-Preferred Brand	4	100000	3	2	4	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2962	004	0	1	01	01	H2962_004_0	10	Specialty Tier	4	010010	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31				848.33	33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2968	001	0	1	04	01	H2968_001_0	10	Preferred Generic	4	001000	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	5.00	10.00	12.50																					10.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2968	001	0	1	04	01	H2968_001_0	10	Generic	4	010000	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	15.00	30.00	37.50																					30.00																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2968	001	0	1	04	01	H2968_001_0	10	Preferred Brand	4	000001	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	45.00	90.00	112.50																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2968	001	0	1	04	01	H2968_001_0	10	Non-Preferred Brand	4	100000	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	99.00	198.00	247.50																					198.00																99.00				99.00		3.30						3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2968	001	0	1	04	01	H2968_001_0	10	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31					27																				27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2986	001	0	1	01	01	H2986_001_0	7	Preferred Generic	4	001000	1	2	1	1	110		01	110		1	34		90				1	2	34		90				34		34	2.00		6.00																			2.00		4.00																2.00				2.00		0.06			0.06			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2986	001	0	1	01	01	H2986_001_0	7	Preferred Generic	4	001000	1	2	1	3	110		01	110		1	34		90				1	2	34		90				34		34	2.00		6.00																			2.00		4.00																2.00				2.00		0.06			0.06			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2986	001	0	1	01	01	H2986_001_0	7	Generic	4	010000	1	2	2	1	110		01	110		1	34		90				1	2	34		90				34		34	15.00		45.00																			15.00		30.00																15.00				15.00		0.44			0.44			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2986	001	0	1	01	01	H2986_001_0	7	Generic	4	010000	1	2	2	3	110		01	110		1	34		90				1	2	34		90				34		34	15.00		45.00																			15.00		30.00																15.00				15.00		0.44			0.44			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2986	001	0	1	01	01	H2986_001_0	7	Preferred Brand	4	000001	1	2	3	1	110		01	110		1	34		90				1	2	34		90				34		34	47.00		141.00																			47.00		94.00																47.00				47.00		1.38			1.38			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2986	001	0	1	01	01	H2986_001_0	7	Non-Preferred Brand	4	100000	1	2	4	1	110		01	110		1	34		90				1	2	34		90				34		34	100.00		300.00																			100.00		200.00																100.00				100.00		2.94			2.94			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2986	001	0	1	01	01	H2986_001_0	7	Specialty Tier	4	001001	1	1	5	1	010		01	010		1	34								34						34		34				200.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2986	002	0	1	01	01	H2986_002_0	6	Preferred Generic	4	001000	1	2	1	1	110		01	110		1	34		90				1	2	34		90				34		34	2.00		6.00																			2.00		4.00																2.00				2.00		0.06			0.06			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2986	002	0	1	01	01	H2986_002_0	6	Preferred Generic	4	001000	1	2	1	3	110		01	110		1	34		90				1	2	34		90				34		34	2.00		6.00																			2.00		4.00																2.00				2.00		0.06			0.06			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2986	002	0	1	01	01	H2986_002_0	6	Generic	4	010000	1	2	2	1	110		01	110		1	34		90				1	2	34		90				34		34	15.00		45.00																			15.00		30.00																15.00				15.00		0.44			0.44			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2986	002	0	1	01	01	H2986_002_0	6	Generic	4	010000	1	2	2	3	110		01	110		1	34		90				1	2	34		90				34		34	15.00		45.00																			15.00		30.00																15.00				15.00		0.44			0.44			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H2986	002	0	1	01	01	H2986_002_0	6	Preferred Brand	4	000001	1	2	3	1	110		01	110		1	34		90				1	2	34		90				34		34	47.00		141.00																			47.00		94.00																47.00				47.00		1.38			1.38			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2986	002	0	1	01	01	H2986_002_0	6	Non-Preferred Brand	4	100000	1	2	4	1	110		01	110		1	34		90				1	2	34		90				34		34	100.00		300.00																			100.00		200.00																100.00				100.00		2.94			2.94			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H2986	002	0	1	01	01	H2986_002_0	6	Specialty Tier	4	001001	1	1	5	1	010		01	010		1	34								34						34		34				200.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3018	001	0	1	48	05	H3018_001_0	4	Generic Drugs	4	010000			1	1	110		01	100		1	30		90				1	2			90				30		31																																														0.00						0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H3018	001	0	1	48	05	H3018_001_0	4	Brand Drugs	4	000010			2	1	110		01	100		1	30		90				1	2			90				30		31																																														0.00						0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H3018	001	0	1	48	05	H3018_001_0	4	Non-Medicare Rx Drugs	4	010010			3	1	110		01	100		1	30		90				1	2			90				30		31																																														0.00						0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H3018	001	0	1	48	05	H3018_001_0	4	Non-Medicare OTC Drugs	4	010010			4	1	110		01	100		1	30		90				1	2			90				30		31																																														0.00						0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H3054	001	0	1	01	01	H3054_001_0	13	Generic	2	010000	1	2	1	1	111		01	100		1	30	60	90				2	1			90				30		31	7.50	15.00	22.50																					15.00																7.50				7.50		0.25						0.24	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3054	001	0	1	01	01	H3054_001_0	13	Preferred Brand	2	000001	1	2	2	1	111		01	100		1	30	60	90				2	1			90				30		31	47.00	94.00	141.00																					94.00																47.00				47.00		1.57						1.52	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3054	001	0	1	01	01	H3054_001_0	13	Non-Preferred Brand	2	100000	1	2	3	1	111		01	100		1	30	60	90				2	1			90				30		31	100.00	200.00	300.00																					200.00																100.00				100.00		3.33						3.23	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3054	001	0	1	01	01	H3054_001_0	13	Specialty Tier	2	010010	1	1	4	1	111		01	100		1	30	60	90				2	1			90				30		31				780.55	25	25	25																				25															25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3054	003	0	1	01	01	H3054_003_0	11	Generic	2	010000	1	2	1	1	111		01	100		1	30	60	90				2	1			90				30		31	7.50	15.00	22.50																					15.00																7.50				7.50		0.25						0.24	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3054	003	0	1	01	01	H3054_003_0	11	Preferred Brand	2	000001	1	2	2	1	111		01	100		1	30	60	90				2	1			90				30		31	47.00	94.00	141.00																					94.00																47.00				47.00		1.57						1.52	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3054	003	0	1	01	01	H3054_003_0	11	Non-Preferred Brand	2	100000	1	2	3	1	111		01	100		1	30	60	90				2	1			90				30		31	100.00	200.00	300.00																					200.00																100.00				100.00		3.33						3.23	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3054	003	0	1	01	01	H3054_003_0	11	Specialty Tier	2	010010	1	1	4	1	111		01	100		1	30	60	90				2	1			90				30		31				780.55	25	25	25																				25															25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3054	004	0	1	01	01	H3054_004_0	11	Generic	2	010000	1	2	1	1	111		01	100		1	30	60	90				2	1			90				30		31	7.75	15.50	23.25																					15.50																7.75				7.75		0.26						0.25	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3054	004	0	1	01	01	H3054_004_0	11	Preferred Brand	2	000001	1	2	2	1	111		01	100		1	30	60	90				2	1			90				30		31	47.00	94.00	141.00																					94.00																47.00				47.00		1.57						1.52	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3054	004	0	1	01	01	H3054_004_0	11	Non-Preferred Brand	2	100000	1	2	3	1	111		01	100		1	30	60	90				2	1			90				30		31	100.00	200.00	300.00																					200.00																100.00				100.00		3.33						3.23	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3054	004	0	1	01	01	H3054_004_0	11	Specialty Tier	2	010010	1	1	4	1	111		01	100		1	30	60	90				2	1			90				30		31				780.55	25	25	25																				25															25			25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3067	001	0	1	48	05	H3067_001_0	5	Generic Drugs	4	010000			1	1	110		01	100		1	34		90				1	2			90				34		34																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	3.30	0.00	3.30			0.00	3.30			
H3067	001	0	1	48	05	H3067_001_0	5	Brand Drugs	4	000010			2	1	110		01	100		1	34		90				1	2			90				34		34																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	8.25	0.00	8.25			0.00	8.25			
H3067	001	0	1	48	05	H3067_001_0	5	Non-Medicare Rx/OTC Drugs	4	100100			3	1	010		01			1	34														34		34																																														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			
H3071	002	0	1	01	01	H3071_002_0	10	Preferred Generic	4	001001	1	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	3.00	1.00	1.00																									9.00	3.00	3.00				3.00	0.00	0.00				3.00				3.00		0.10				0.30	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3071	002	0	1	01	01	H3071_002_0	10	Generic	4	010001	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	10.00	20.00	30.00																									30.00	60.00	90.00				10.00	20.00	30.00				10.00				10.00		0.33				1.00	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3071	002	0	1	01	01	H3071_002_0	10	Preferred Brand	4	000101	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	47.00	94.00	141.00																									141.00	282.00	423.00				47.00	94.00	141.00				47.00				47.00		1.57				4.70	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3071	002	0	1	01	01	H3071_002_0	10	Non-Preferred Drug	4	100100	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				76.72	50	50	50																								50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3071	002	0	1	01	01	H3071_002_0	10	Specialty Tier	4	010010	1	1	5	1	111		01		111	1	30	60	90				2	2				30	60	90	30		31				628.83	33	33	33																								33	33	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3113	008	0	1	01	01	H3113_008_0	7	Preferred Generic	3	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3113	008	0	1	01	01	H3113_008_0	7	Generic	3	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3113	008	0	1	01	01	H3113_008_0	7	Preferred Brand	3	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3113	008	0	1	01	01	H3113_008_0	7	Non-Preferred Drug	3	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3113	008	0	1	01	01	H3113_008_0	7	Specialty Tier	3	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				461.00	31		31																										31						31			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3129	001	0	1	48	05	H3129_001_0	3	Generic Drugs	4	010000			1	1	110		01	100		1	30		90				1	2			90				30		31																																														0.00						0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H3129	001	0	1	48	05	H3129_001_0	3	Brand Drugs	4	000010			2	1	110		01	100		1	30		90				1	2			90				30		31																																														0.00						0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H3129	001	0	1	48	05	H3129_001_0	3	Non-Medicare Rx/OTC Drugs	4	010010			3	1	010		01			1	30														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			
H3132	001	0	1	01	01	H3132_001_0	6	Generic	2	010000	1	1	1	1	110		10			1	30		90				1	2								29	34				8.84	25		25																																				25		25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3132	001	0	1	01	01	H3132_001_0	6	Preferred Brand	2	000101	1	1	2	1	110		10			1	30		90				1	2								29	34				70.78	25		25																																				25		25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3132	001	0	1	01	01	H3132_001_0	6	Non-Preferred Brand	2	100000	1	1	3	1	010		10			1	30															29	34				90.54	25																																						25		25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3132	001	0	1	01	01	H3132_001_0	6	Specialty Tier	2	100000	1	1	4	1	010		10			1	30															29	34				348.23	25																																						25		25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3152	022	0	1	01	01	H3152_022_0	4	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3152	022	0	1	01	01	H3152_022_0	4	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3152	022	0	1	01	01	H3152_022_0	4	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3152	022	0	1	01	01	H3152_022_0	4	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3152	022	0	1	01	01	H3152_022_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3152	022	0	1	01	01	H3152_022_0	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3152	022	0	1	01	01	H3152_022_0	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	27						1.00	27												27						27						27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3152	048	0	1	01	01	H3152_048_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3152	048	0	1	01	01	H3152_048_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3152	048	0	1	01	01	H3152_048_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3152	048	0	1	01	01	H3152_048_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3152	048	0	1	01	01	H3152_048_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3152	048	0	1	01	01	H3152_048_0	3	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3152	048	0	1	01	01	H3152_048_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	29						1.00	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3152	080	0	1	01	01	H3152_080_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3152	080	0	1	01	01	H3152_080_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3152	080	0	1	01	01	H3152_080_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3152	080	0	1	01	01	H3152_080_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3152	080	0	1	01	01	H3152_080_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3152	080	0	1	01	01	H3152_080_0	3	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3152	080	0	1	01	01	H3152_080_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	26						1.00	26												26						26						26		26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3152	082	0	1	01	01	H3152_082_0	4	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3152	082	0	1	01	01	H3152_082_0	4	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3152	082	0	1	01	01	H3152_082_0	4	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3152	082	0	1	01	01	H3152_082_0	4	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3152	082	0	1	01	01	H3152_082_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3154	004	0	1	01	01	H3154_004_0	9	Preferred Generic	2	001000	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					2.50	5.00	7.50																5.00				5.00			0.17	0.00	0.08			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3154	004	0	1	01	01	H3154_004_0	9	Generic	2	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								11.00	22.00	33.00					6.00	12.00	18.00					5.50	11.00	16.50																11.00				11.00			0.37	0.20	0.18			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3154	004	0	1	01	01	H3154_004_0	9	Preferred Brand	2	010001	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								45.00	90.00	135.00					40.00	80.00	120.00					45.00	90.00	135.00																45.00				45.00			1.50	1.33	1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3154	004	0	1	01	01	H3154_004_0	9	Non-Preferred Brand	2	110000	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																90.00				90.00			3.00	2.67	3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3154	004	0	1	01	01	H3154_004_0	9	Specialty Tier	2	010010	1	1	5	1		010	01			1				30											30		31											560.93	25						560.93	25																							25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3154	022	0	1	01	01	H3154_022_0	8	Preferred Generic	2	001000	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					2.50	5.00	7.50																5.00				5.00			0.17	0.00	0.08			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3154	022	0	1	01	01	H3154_022_0	8	Generic	2	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								11.00	22.00	33.00					6.00	12.00	18.00					5.50	11.00	16.50																11.00				11.00			0.37	0.20	0.18			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3154	022	0	1	01	01	H3154_022_0	8	Preferred Brand	2	010001	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								45.00	90.00	135.00					40.00	80.00	120.00					45.00	90.00	135.00																45.00				45.00			1.50	1.33	1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3154	022	0	1	01	01	H3154_022_0	8	Non-Preferred Brand	2	110000	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																90.00				90.00			3.00	2.67	3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3154	022	0	1	01	01	H3154_022_0	8	Specialty Tier	2	010010	1	1	5	1		010	01			1				30											30		31											726.96	25						726.96	25																							25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3154	024	0	1	01	01	H3154_024_0	9	Preferred Generic	2	001000	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					2.50	5.00	7.50																5.00				5.00			0.17	0.00	0.08			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3154	024	0	1	01	01	H3154_024_0	9	Generic	2	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					5.00	10.00	15.00					5.00	10.00	15.00																10.00				10.00			0.33	0.17	0.17			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3154	024	0	1	01	01	H3154_024_0	9	Preferred Brand	2	010001	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																40.00				40.00			1.33	1.17	1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3154	024	0	1	01	01	H3154_024_0	9	Non-Preferred Brand	2	110000	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								85.00	170.00	255.00					70.00	140.00	210.00					85.00	170.00	255.00																85.00				85.00			2.83	2.33	2.83			2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3154	024	0	1	01	01	H3154_024_0	9	Specialty Tier	2	010010	1	1	5	1		010	01			1				30											30		31											225.07	25						225.07	25																							25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3154	026	0	1	01	01	H3154_026_0	9	Preferred Generic	2	001000	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					2.50	5.00	7.50																5.00				5.00			0.17	0.00	0.08			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3154	026	0	1	01	01	H3154_026_0	9	Generic	2	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					5.00	10.00	15.00					5.00	10.00	15.00																10.00				10.00			0.33	0.17	0.17			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3154	026	0	1	01	01	H3154_026_0	9	Preferred Brand	2	010001	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																40.00				40.00			1.33	1.17	1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3154	026	0	1	01	01	H3154_026_0	9	Non-Preferred Brand	2	110000	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								85.00	170.00	255.00					80.00	160.00	240.00					85.00	170.00	255.00																85.00				85.00			2.83	2.67	2.83			2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3154	026	0	1	01	01	H3154_026_0	9	Specialty Tier	2	010010	1	1	5	1		010	01			1				30											30		31											221.53	25						221.53	25																							25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3154	027	0	1	01	01	H3154_027_0	8	Preferred Generic	2	001000	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					2.50	5.00	7.50																5.00				5.00			0.17	0.00	0.08			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3154	027	0	1	01	01	H3154_027_0	8	Generic	2	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					5.00	10.00	15.00					5.00	10.00	15.00																10.00				10.00			0.33	0.17	0.17			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3154	027	0	1	01	01	H3154_027_0	8	Preferred Brand	2	010001	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																40.00				40.00			1.33	1.17	1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3154	027	0	1	01	01	H3154_027_0	8	Non-Preferred Brand	2	110000	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																80.00				80.00			2.67	2.33	2.67			2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3154	027	0	1	01	01	H3154_027_0	8	Specialty Tier	2	010010	1	1	5	1		010	01			1				30											30		31											235.92	25						235.92	25																							25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3154	028	0	1	01	01	H3154_028_0	9	Preferred Generic	2	001000	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					2.50	5.00	7.50																5.00				5.00			0.17	0.00	0.08			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3154	028	0	1	01	01	H3154_028_0	9	Generic	2	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					5.00	10.00	15.00					5.00	10.00	15.00																10.00				10.00			0.33	0.17	0.17			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3154	028	0	1	01	01	H3154_028_0	9	Preferred Brand	2	010001	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																40.00				40.00			1.33	1.17	1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3154	028	0	1	01	01	H3154_028_0	9	Non-Preferred Brand	2	110000	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																75.00				75.00			2.50	2.17	2.50			2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3154	028	0	1	01	01	H3154_028_0	9	Specialty Tier	2	010010	1	1	5	1		010	01			1				30											30		31											197.13	25						197.13	25																							25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3170	001	0	1	01	01	H3170_001_0	9	Preferred Generic	4	001000	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								14.00		42.00					4.00		12.00					4.00		12.00																14.00				4.00			0.47	0.13	0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3170	001	0	1	01	01	H3170_001_0	9	Generic	4	010000	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								18.00		54.00					8.00		24.00					8.00		24.00																18.00				8.00			0.60	0.27	0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3170	001	0	1	01	01	H3170_001_0	9	Preferred Brand	4	000001	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		141.00					37.00		111.00					37.00		111.00																47.00				37.00			1.57	1.23	1.23			1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3170	001	0	1	01	01	H3170_001_0	9	Non-Preferred Brand	4	110000	1	1	4	1		110	01	110		1				30		90	1	2	30		90				30		31											64.00	50		50				55.00	45		45				45		45															50			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3170	001	0	1	01	01	H3170_001_0	9	Specialty Tier	4	010010	1	1	5	1		110	01	110		1				30		90	1	2	30		90				30		31											1.00	25		25				1.00	25		25				25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3170	002	0	1	02	01	H3170_002_0	7	Preferred Generic	4	001000	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								12.00		36.00					2.00		6.00					2.00		6.00																12.00				2.00			0.40	0.07	0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3170	002	0	1	02	01	H3170_002_0	7	Generic	4	010000	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								18.00		54.00					8.00		24.00					8.00		24.00																18.00				8.00			0.60	0.27	0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3170	002	0	1	02	01	H3170_002_0	7	Preferred Brand	4	000001	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		141.00					37.00		111.00					37.00		111.00																47.00				37.00			1.57	1.23	1.23			1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3170	002	0	1	02	01	H3170_002_0	7	Non-Preferred Brand	4	110000	1	1	4	1		110	01	110		1				30		90	1	2	30		90				30		31											61.00	50		50				52.00	45		45				45		45															50			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3170	002	0	1	02	01	H3170_002_0	7	Specialty Tier	4	010010	1	1	5	1		110	01	110		1				30		90	1	2	30		90				30		31											1.00	27		27				1.00	27		27				27		27															27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3204	001	0	1	01	01	H3204_001_0	5	Preferred Generic	4	001000	1	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	4.00	8.00	12.00																									4.00	8.00	12.00				4.00	8.00	8.00				4.00				4.00		0.13				0.13	0.13	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3204	001	0	1	01	01	H3204_001_0	5	Generic	4	010000	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	10.00	20.00	30.00																									10.00	20.00	30.00				10.00	20.00	20.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3204	001	0	1	01	01	H3204_001_0	5	Preferred Brand	4	000001	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	45.00	90.00	135.00																									45.00	90.00	135.00				45.00	90.00	112.50				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3204	001	0	1	01	01	H3204_001_0	5	Non-Preferred Brand	4	101000	1	2	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	95.00	190.00	285.00																									95.00	190.00	285.00				95.00	190.00	285.00				95.00				95.00		3.17				3.17	3.17	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3204	001	0	1	01	01	H3204_001_0	5	Specialty Tier	4	010010	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												
H3204	007	0	1	01	01	H3204_007_0	5	Preferred Generic	4	001000	1	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	4.00	8.00	12.00																									4.00	8.00	12.00				4.00	8.00	8.00				4.00				4.00		0.13				0.13	0.13	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3204	007	0	1	01	01	H3204_007_0	5	Preferred Generic	4	001000	1	2	1	3	111		01		111	1	30	60	90				1	2				30	60	90	30		31	4.00	8.00	12.00																									4.00	8.00	12.00				4.00	8.00	8.00				4.00				4.00		0.13				0.13	0.13	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3204	007	0	1	01	01	H3204_007_0	5	Generic	4	010000	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	10.00	20.00	30.00																									10.00	20.00	30.00				10.00	20.00	20.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3204	007	0	1	01	01	H3204_007_0	5	Generic	4	010000	1	2	2	3	111		01		111	1	30	60	90				1	2				30	60	90	30		31	10.00	20.00	30.00																									10.00	20.00	30.00				10.00	20.00	20.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3204	007	0	1	01	01	H3204_007_0	5	Preferred Brand	4	000001	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	45.00	90.00	135.00																									45.00	90.00	135.00				45.00	90.00	112.50				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3204	007	0	1	01	01	H3204_007_0	5	Non-Preferred Brand	4	100100	1	2	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	95.00	190.00	285.00																									95.00	190.00	285.00				95.00	190.00	285.00				95.00				95.00		3.17				3.17	3.17	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3204	007	0	1	01	01	H3204_007_0	5	Specialty Tier	4	010010	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												
H3206	001	0	1	04	01	H3206_001_0	7	Preferred Generic	3	001000	1	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	4.00	8.00	12.00																									4.00	8.00	12.00				4.00	8.00	8.00				4.00				4.00		0.13				0.13	0.13	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3206	001	0	1	04	01	H3206_001_0	7	Generic	3	010000	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	10.00	20.00	30.00																									10.00	20.00	30.00				10.00	20.00	20.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3206	001	0	1	04	01	H3206_001_0	7	Preferred Brand	3	000001	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	45.00	90.00	135.00																									45.00	90.00	135.00				45.00	90.00	112.50				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3206	001	0	1	04	01	H3206_001_0	7	Non-Preferred Brand	3	100100	1	2	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	95.00	190.00	285.00																									95.00	190.00	285.00				95.00	190.00	285.00				95.00				95.00		3.17				3.17	3.17	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3206	001	0	1	04	01	H3206_001_0	7	Specialty Tier	3	010010	1	1	5	1	010		01		010	1	30											30			30		31					25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3206	002	0	1	04	01	H3206_002_0	7	Preferred Generic	4	001000	1	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	4.00	8.00	12.00																									4.00	8.00	12.00				4.00	8.00	8.00				4.00				4.00		0.13				0.13	0.13	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3206	002	0	1	04	01	H3206_002_0	7	Preferred Generic	4	001000	1	2	1	3	111		01		111	1	30	60	90				1	2				30	60	90	30		31	4.00	8.00	12.00																									4.00	8.00	12.00				4.00	8.00	8.00				4.00				4.00		0.13				0.13	0.13	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3206	002	0	1	04	01	H3206_002_0	7	Generic	4	010000	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	10.00	20.00	30.00																									10.00	20.00	30.00				10.00	20.00	20.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3206	002	0	1	04	01	H3206_002_0	7	Generic	4	010000	1	2	2	3	111		01		111	1	30	60	90				1	2				30	60	90	30		31	10.00	20.00	30.00																									10.00	20.00	30.00				10.00	20.00	20.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3206	002	0	1	04	01	H3206_002_0	7	Preferred Brand	4	000001	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	45.00	90.00	135.00																									45.00	90.00	135.00				45.00	90.00	112.50				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3206	002	0	1	04	01	H3206_002_0	7	Non-Preferred Brand	4	100100	1	2	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	95.00	190.00	285.00																									95.00	190.00	285.00				95.00	190.00	285.00				95.00				95.00		3.17				3.17	3.17	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3206	002	0	1	04	01	H3206_002_0	7	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31					28																										28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3233	001	0	1	01	01	H3233_001_0	7	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	9.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3233	001	0	1	01	01	H3233_001_0	7	Preferred Generic	4	001000	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	9.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H3233	001	0	1	01	01	H3233_001_0	7	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	45.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3233	001	0	1	01	01	H3233_001_0	7	Preferred Brand	4	010001	1	2	3	1	111		01	111		1	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, Select Care Drugs												
H3233	001	0	1	01	01	H3233_001_0	7	Non-Preferred Brand	4	110000	1	2	4	1	111		01	111		1	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, Select Care Drugs												
H3233	001	0	1	01	01	H3233_001_0	7	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31					31																				31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3233	001	0	1	01	01	H3233_001_0	7	Select Care Drugs	4	010000	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3233	001	0	1	01	01	H3233_001_0	7	Select Care Drugs	4	010000	1	2	6	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H3237	001	0	1	48	05	H3237_001_0	6	Generic Drugs	4	010000			1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	3.30	0.00	3.30	0.00	3.30	0.00	3.30			
H3237	001	0	1	48	05	H3237_001_0	6	Brand Drugs	4	000010			2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	8.25	0.00	8.25	0.00	8.25	0.00	8.25			
H3237	001	0	1	48	05	H3237_001_0	6	Non-Medicare Rx/OTC Drugs	4	010010			3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31																																														0.00			0.00			0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H3237	002	0	1	48	05	H3237_002_0	6	Generic Drugs	4	010000			1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	3.30	0.00	3.30	0.00	3.30	0.00	3.30			
H3237	002	0	1	48	05	H3237_002_0	6	Brand Drugs	4	000010			2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	8.25	0.00	8.25	0.00	8.25	0.00	8.25			
H3237	002	0	1	48	05	H3237_002_0	6	Non-Medicare Rx/OTC Drugs	4	010010			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			
H3240	013	0	1	01	01	H3240_013_0	8	Preferred Generic	3	001000	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	013	0	1	01	01	H3240_013_0	8	Generic	3	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								11.00	22.00	33.00					11.00	22.00	33.00					11.00	33.00	33.00																11.00				11.00			0.37	0.37	0.37			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3240	013	0	1	01	01	H3240_013_0	8	Preferred Brand	3	000101	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												
H3240	013	0	1	01	01	H3240_013_0	8	Non-Preferred Drug	3	100100	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												
H3240	013	0	1	01	01	H3240_013_0	8	Specialty Tier	3	010010	1	1	5	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	8	Select Care Drugs	3	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3240	016	0	1	01	01	H3240_016_0	6	Preferred Generic	3	001000	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	016	0	1	01	01	H3240_016_0	6	Generic	3	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								14.00	28.00	42.00					14.00	28.00	42.00					14.00	42.00	42.00																14.00				14.00			0.47	0.47	0.47			0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3240	016	0	1	01	01	H3240_016_0	6	Preferred Brand	3	000101	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								45.00	90.00	135.00					45.00	90.00	135.00					45.00	135.00	135.00																45.00				45.00			1.50	1.50	1.50			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3240	016	0	1	01	01	H3240_016_0	6	Non-Preferred Drug	3	100100	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												
H3240	016	0	1	01	01	H3240_016_0	6	Specialty Tier	3	010010	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3240	016	0	1	01	01	H3240_016_0	6	Select Care Drugs	3	001000	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			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	7	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								12.00	24.00	36.00					7.00	14.00	21.00					7.00	21.00	21.00																12.00				12.00			0.40	0.23	0.23			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3240	017	0	1	02	01	H3240_017_0	7	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								13.00	26.00	39.00					8.00	16.00	24.00					8.00	24.00	24.00																13.00				13.00			0.43	0.27	0.27			0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3240	017	0	1	02	01	H3240_017_0	7	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	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	7	Non-Preferred Drug	4	100100	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												
H3240	017	0	1	02	01	H3240_017_0	7	Specialty Tier	4	010010	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												
H3240	017	0	1	02	01	H3240_017_0	7	Select Care Drugs	4	001000	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			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	8	Preferred Generic	4	001000	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							27.00																9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3251	002	0	1	01	01	H3251_002_0	8	Preferred Generic	4	001000	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							27.00																9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3251	002	0	1	01	01	H3251_002_0	8	Generic	4	010010	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		60.00					9.00		27.00							60.00																20.00				20.00			0.67	0.30				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3251	002	0	1	01	01	H3251_002_0	8	Generic	4	010010	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								20.00		60.00					9.00		27.00							60.00																20.00				20.00			0.67	0.30				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3251	002	0	1	01	01	H3251_002_0	8	Preferred Brand	4	010001	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					39.00		117.00							141.00																47.00				47.00			1.57	1.30				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3251	002	0	1	01	01	H3251_002_0	8	Non-Preferred Brand	4	110000	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								100.00		300.00					95.00		285.00							300.00																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3251	002	0	1	01	01	H3251_002_0	8	Specialty Tier	4	010010	1	1	5	1		110	01	100		1				30		90	1	2			90				30		31											1088.82	33		33				1130.26	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3251	021	0	1	02	01	H3251_021_0	9	Preferred Generic	4	001000	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							27.00																9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3251	021	0	1	02	01	H3251_021_0	9	Preferred Generic	4	001000	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							27.00																9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3251	021	0	1	02	01	H3251_021_0	9	Generic	4	010010	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		60.00					9.00		27.00							60.00																20.00				20.00			0.67	0.30				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3251	021	0	1	02	01	H3251_021_0	9	Generic	4	010010	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								20.00		60.00					9.00		27.00							60.00																20.00				20.00			0.67	0.30				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3251	021	0	1	02	01	H3251_021_0	9	Preferred Brand	4	010001	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					39.00		117.00							141.00																47.00				47.00			1.57	1.30				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3251	021	0	1	02	01	H3251_021_0	9	Non-Preferred Brand	4	110000	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								100.00		300.00					95.00		285.00							300.00																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3251	021	0	1	02	01	H3251_021_0	9	Specialty Tier	4	010010	1	1	5	1		110	01	100		1				30		90	1	2			90				30		31											1465.72	33		33				1466.53	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3262	001	0	1	01	01	H3262_001_0	7	Preferred Generic	4	001000	1	2	1	1	110		10	100		1	31		90				1	2			90					10	31	0.00		0.00																					0.00																	0.00			0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3262	001	0	1	01	01	H3262_001_0	7	Generic	4	010000	1	1	2	1	110		10	100		1	31		90				1	2			90					10	31				14.90	25		25																				25																25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3262	001	0	1	01	01	H3262_001_0	7	Preferred Brand	4	000001	1	1	3	1	110		10	100		1	31		90				1	2			90					10	31				67.40	25		25																				25																25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3262	001	0	1	01	01	H3262_001_0	7	Non-Preferred Brand	4	100000	1	1	4	1	110		10	100		1	31		90				1	2			90					10	31				188.71	25		25																				25																25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3262	001	0	1	01	01	H3262_001_0	7	Specialty Tier	4	010010	1	1	5	1	010		10	010		1	31								30							10	31				600.00	25																				25																		25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3305	015	0	1	02	01	H3305_015_0	14	Preferred Generic	4	001000	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		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												
H3305	015	0	1	02	01	H3305_015_0	14	Preferred Generic	4	001000	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, Vaccines										1		
H3305	015	0	1	02	01	H3305_015_0	14	Generic	4	010000	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		20.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H3305	015	0	1	02	01	H3305_015_0	14	Preferred Brand	4	000101	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	40.00		120.00																									40.00		120.00				40.00		80.00				40.00				40.00		1.33				1.33	1.33	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H3305	015	0	1	02	01	H3305_015_0	14	Non-Preferred Drug	4	100100	1	1	4	1	110		01		110	1	30		90				2	2				30		90	30		31				83.63	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H3305	015	0	1	02	01	H3305_015_0	14	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				777.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H3305	015	0	1	02	01	H3305_015_0	14	Vaccines	4	010010	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												
H3305	015	0	1	02	01	H3305_015_0	14	Vaccines	4	010010	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		
H3305	021	0	1	02	01	H3305_021_0	15	Preferred Generic	4	001000	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		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												
H3305	021	0	1	02	01	H3305_021_0	15	Preferred Generic	4	001000	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, Vaccines										1		
H3305	021	0	1	02	01	H3305_021_0	15	Generic	4	010000	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		20.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H3305	021	0	1	02	01	H3305_021_0	15	Preferred Brand	4	000101	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	35.00		105.00																									35.00		105.00				35.00		70.00				35.00				35.00		1.17				1.17	1.17	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H3305	021	0	1	02	01	H3305_021_0	15	Non-Preferred Drug	4	100100	1	1	4	1	110		01		110	1	30		90				2	2				30		90	30		31				92.20	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H3305	021	0	1	02	01	H3305_021_0	15	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				777.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H3305	021	0	1	02	01	H3305_021_0	15	Vaccines	4	010010	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												
H3305	021	0	1	02	01	H3305_021_0	15	Vaccines	4	010010	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		
H3305	022	0	1	02	01	H3305_022_0	15	Preferred Generic	4	001000	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		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												
H3305	022	0	1	02	01	H3305_022_0	15	Preferred Generic	4	001000	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, Vaccines										1		
H3305	022	0	1	02	01	H3305_022_0	15	Generic	4	010000	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		30.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H3305	022	0	1	02	01	H3305_022_0	15	Preferred Brand	4	000101	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		90.00				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H3305	022	0	1	02	01	H3305_022_0	15	Non-Preferred Drug	4	100100	1	1	4	1	110		01		110	1	30		90				2	2				30		90	30		31				80.12	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H3305	022	0	1	02	01	H3305_022_0	15	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				777.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H3305	022	0	1	02	01	H3305_022_0	15	Vaccines	4	010010	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												
H3305	022	0	1	02	01	H3305_022_0	15	Vaccines	4	010010	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		
H3307	002	0	1	01	01	H3307_002_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	002	0	1	01	01	H3307_002_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	002	0	1	01	01	H3307_002_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	002	0	1	01	01	H3307_002_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	002	0	1	01	01	H3307_002_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				783.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	012	0	1	01	01	H3307_012_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	012	0	1	01	01	H3307_012_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	012	0	1	01	01	H3307_012_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	012	0	1	01	01	H3307_012_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	012	0	1	01	01	H3307_012_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				881.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	015	0	1	01	01	H3307_015_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	015	0	1	01	01	H3307_015_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	13.00		39.00																											39.00						0.00				13.00				13.00		0.43						0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	015	0	1	01	01	H3307_015_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	43.00		129.00																											129.00						119.00				43.00				43.00		1.43						1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	015	0	1	01	01	H3307_015_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	93.00		279.00																											279.00						269.00				93.00				93.00		3.10						3.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	015	0	1	01	01	H3307_015_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				590.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	023	0	1	01	01	H3307_023_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	023	0	1	01	01	H3307_023_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	023	0	1	01	01	H3307_023_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	023	0	1	01	01	H3307_023_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	023	0	1	01	01	H3307_023_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				773.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	024	0	1	01	01	H3307_024_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	024	0	1	01	01	H3307_024_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	024	0	1	01	01	H3307_024_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	024	0	1	01	01	H3307_024_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	024	0	1	01	01	H3307_024_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				898.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	025	0	1	01	01	H3307_025_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	025	0	1	01	01	H3307_025_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	025	0	1	01	01	H3307_025_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	025	0	1	01	01	H3307_025_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3307	025	0	1	01	01	H3307_025_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				881.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3312	002	0	1	01	01	H3312_002_0	4	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3312	002	0	1	01	01	H3312_002_0	4	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3312	002	0	1	01	01	H3312_002_0	4	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3312	002	0	1	01	01	H3312_002_0	4	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3312	002	0	1	01	01	H3312_002_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3312	002	0	1	01	01	H3312_002_0	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3312	002	0	1	01	01	H3312_002_0	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	27						1.00	27												27						27						27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3312	018	0	1	01	01	H3312_018_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3312	018	0	1	01	01	H3312_018_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3312	018	0	1	01	01	H3312_018_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3312	018	0	1	01	01	H3312_018_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3312	018	0	1	01	01	H3312_018_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3312	018	0	1	01	01	H3312_018_0	3	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3312	018	0	1	01	01	H3312_018_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	28						1.00	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3312	048	0	1	01	01	H3312_048_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3312	048	0	1	01	01	H3312_048_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3312	048	0	1	01	01	H3312_048_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3312	048	0	1	01	01	H3312_048_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3312	048	0	1	01	01	H3312_048_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3312	048	0	1	01	01	H3312_048_0	3	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3312	048	0	1	01	01	H3312_048_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	31						1.00	31												31						31						31		31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3312	060	0	1	01	01	H3312_060_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3312	060	0	1	01	01	H3312_060_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3312	060	0	1	01	01	H3312_060_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3312	060	0	1	01	01	H3312_060_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3312	060	0	1	01	01	H3312_060_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	060	0	1	01	01	H3312_060_0	3	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	060	0	1	01	01	H3312_060_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	26						1.00	26												26						26						26		26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3312	062	0	1	01	01	H3312_062_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3312	062	0	1	01	01	H3312_062_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3312	062	0	1	01	01	H3312_062_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3312	062	0	1	01	01	H3312_062_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3312	062	0	1	01	01	H3312_062_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3312	062	0	1	01	01	H3312_062_0	3	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3312	062	0	1	01	01	H3312_062_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	29						1.00	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3328	002	0	1	01	01	H3328_002_0	9	Preferred Generic	3	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		34	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3328	002	0	1	01	01	H3328_002_0	9	Generic	3	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		34	20.00		60.00																					40.00																20.00				20.00		0.67						0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3328	002	0	1	01	01	H3328_002_0	9	Preferred Brand	3	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		34	47.00		141.00																					94.00																47.00				47.00		1.57						1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3328	002	0	1	01	01	H3328_002_0	9	Non-Preferred Drug	3	100000	1	2	4	1	110		01	100		1	30		90				1	2			90				30		34	100.00		300.00																					200.00																100.00				100.00		3.33						2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3328	002	0	1	01	01	H3328_002_0	9	Specialty Tier	3	010010	1	1	5	1	010		01	010		1	30								30						30		34				422.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3328	003	0	1	02	01	H3328_003_0	10	Preferred Generic	3	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		34	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3328	003	0	1	02	01	H3328_003_0	10	Generic	3	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		34	15.00		45.00																					30.00																15.00				15.00		0.50						0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3328	003	0	1	02	01	H3328_003_0	10	Preferred Brand	3	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		34	35.00		105.00																					70.00																35.00				35.00		1.17						1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3328	003	0	1	02	01	H3328_003_0	10	Non-Preferred Drug	3	100000	1	2	4	1	110		01	100		1	30		90				1	2			90				30		34	100.00		300.00																					200.00																100.00				100.00		3.33						2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3328	003	0	1	02	01	H3328_003_0	10	Specialty Tier	3	010010	1	1	5	1	010		01	010		1	30								30						30		34				1102.00	28																				28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3328	016	0	1	01	01	H3328_016_0	12	Preferred Generic	2	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		34	1.00		3.00																					2.00																1.00				1.00		0.03						0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3328	016	0	1	01	01	H3328_016_0	12	Generic	2	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		34	16.00		48.00																					32.00																16.00				16.00		0.53						0.47	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3328	016	0	1	01	01	H3328_016_0	12	Preferred Brand	2	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		34	47.00		141.00																					94.00																47.00				47.00		1.57						1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3328	016	0	1	01	01	H3328_016_0	12	Non-Preferred Drug	2	100000	1	2	4	1	110		01	100		1	30		90				1	2			90				30		34	100.00		300.00																					200.00																100.00				100.00		3.33						2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3328	016	0	1	01	01	H3328_016_0	12	Specialty Tier	2	010010	1	1	5	1	010		01	010		1	30								30						30		34				491.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3328	017	0	1	01	01	H3328_017_0	9	Preferred Generic	3	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		34	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3328	017	0	1	01	01	H3328_017_0	9	Generic	3	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		34	20.00		60.00																					40.00																20.00				20.00		0.67						0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3328	017	0	1	01	01	H3328_017_0	9	Preferred Brand	3	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		34	47.00		141.00																					94.00																47.00				47.00		1.57						1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3328	017	0	1	01	01	H3328_017_0	9	Non-Preferred Drug	3	100000	1	2	4	1	110		01	100		1	30		90				1	2			90				30		34	100.00		300.00																					200.00																100.00				100.00		3.33						2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3328	017	0	1	01	01	H3328_017_0	9	Specialty Tier	3	010010	1	1	5	1	010		01	010		1	30								30						30		34				428.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3328	020	1	1	01	01	H3328_020_1	10	Preferred Generic	3	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		34	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3328	020	1	1	01	01	H3328_020_1	10	Generic	3	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		34	20.00		60.00																					40.00																20.00				20.00		0.67						0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3328	020	1	1	01	01	H3328_020_1	10	Preferred Brand	3	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		34	47.00		141.00																					94.00																47.00				47.00		1.57						1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3328	020	1	1	01	01	H3328_020_1	10	Non-Preferred Drug	3	100000	1	2	4	1	110		01	100		1	30		90				1	2			90				30		34	100.00		300.00																					200.00																100.00				100.00		3.33						2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3328	020	1	1	01	01	H3328_020_1	10	Specialty Tier	3	010010	1	1	5	1	010		01	010		1	30								30						30		34				1266.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3328	020	2	1	01	01	H3328_020_2	10	Preferred Generic	3	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		34	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3328	020	2	1	01	01	H3328_020_2	10	Generic	3	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		34	20.00		60.00																					40.00																20.00				20.00		0.67						0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3328	020	2	1	01	01	H3328_020_2	10	Preferred Brand	3	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		34	47.00		141.00																					94.00																47.00				47.00		1.57						1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3328	020	2	1	01	01	H3328_020_2	10	Non-Preferred Drug	3	100000	1	2	4	1	110		01	100		1	30		90				1	2			90				30		34	100.00		300.00																					200.00																100.00				100.00		3.33						2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3328	020	2	1	01	01	H3328_020_2	10	Specialty Tier	3	010010	1	1	5	1	010		01	010		1	30								30						30		34				1266.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	021	1	1	01	01	H3330_021_1	9	Preferred Generic	3	001000	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			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	021	1	1	01	01	H3330_021_1	9	Generic	3	010000	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	30.00																20.00				20.00			0.67	0.33	0.33			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	021	1	1	01	01	H3330_021_1	9	Preferred Brand	3	000001	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			1.57	1.33	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	021	1	1	01	01	H3330_021_1	9	Non-Preferred Drug	3	110000	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31											191.42	25	25	25				176.10	23	23	23				23	23	23															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	021	1	1	01	01	H3330_021_1	9	Specialty Tier	3	010010	1	1	5	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31											702.11	25	25	25				702.11	25	25	25				25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	021	2	1	01	01	H3330_021_2	9	Preferred Generic	3	001000	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			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	021	2	1	01	01	H3330_021_2	9	Generic	3	010000	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	30.00																20.00				20.00			0.67	0.33	0.33			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	021	2	1	01	01	H3330_021_2	9	Preferred Brand	3	000001	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			1.57	1.33	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	021	2	1	01	01	H3330_021_2	9	Non-Preferred Drug	3	110000	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31											191.42	25	25	25				176.10	23	23	23				23	23	23															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	021	2	1	01	01	H3330_021_2	9	Specialty Tier	3	010010	1	1	5	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31											702.11	25	25	25				702.11	25	25	25				25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	021	3	1	01	01	H3330_021_3	9	Preferred Generic	3	001000	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			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	021	3	1	01	01	H3330_021_3	9	Generic	3	010000	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	30.00																20.00				20.00			0.67	0.33	0.33			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	021	3	1	01	01	H3330_021_3	9	Preferred Brand	3	000001	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			1.57	1.33	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	021	3	1	01	01	H3330_021_3	9	Non-Preferred Drug	3	110000	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31											191.42	25	25	25				176.10	23	23	23				23	23	23															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	021	3	1	01	01	H3330_021_3	9	Specialty Tier	3	010010	1	1	5	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31											702.11	25	25	25				702.11	25	25	25				25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	021	4	1	01	01	H3330_021_4	9	Preferred Generic	3	001000	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			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	021	4	1	01	01	H3330_021_4	9	Generic	3	010000	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	30.00																20.00				20.00			0.67	0.33	0.33			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	021	4	1	01	01	H3330_021_4	9	Preferred Brand	3	000001	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			1.57	1.33	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	021	4	1	01	01	H3330_021_4	9	Non-Preferred Drug	3	110000	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31											191.42	25	25	25				176.10	23	23	23				23	23	23															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	021	4	1	01	01	H3330_021_4	9	Specialty Tier	3	010010	1	1	5	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31											702.11	25	25	25				702.11	25	25	25				25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	032	1	1	01	01	H3330_032_1	5	Preferred Generic	3	001000	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			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	032	1	1	01	01	H3330_032_1	5	Generic	3	010000	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								20.00	40.00	60.00					16.00	32.00	48.00					16.00	32.00	48.00																20.00				20.00			0.67	0.53	0.53			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	032	1	1	01	01	H3330_032_1	5	Preferred Brand	3	000001	1	2	3	1		111	01	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	126.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	032	1	1	01	01	H3330_032_1	5	Non-Preferred Drug	3	110000	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31											222.76	25	25	25				204.94	23	23	23				23	23	23															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	032	1	1	01	01	H3330_032_1	5	Specialty Tier	3	010010	1	1	5	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31											711.60	25	25	25				711.60	25	25	25				25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	032	2	1	01	01	H3330_032_2	5	Preferred Generic	3	001000	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			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	032	2	1	01	01	H3330_032_2	5	Generic	3	010000	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								20.00	40.00	60.00					16.00	32.00	48.00					16.00	32.00	48.00																20.00				20.00			0.67	0.53	0.53			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	032	2	1	01	01	H3330_032_2	5	Preferred Brand	3	000001	1	2	3	1		111	01	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	126.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	032	2	1	01	01	H3330_032_2	5	Non-Preferred Drug	3	110000	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31											222.76	25	25	25				204.94	23	23	23				23	23	23															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	032	2	1	01	01	H3330_032_2	5	Specialty Tier	3	010010	1	1	5	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31											711.60	25	25	25				711.60	25	25	25				25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	032	3	1	01	01	H3330_032_3	6	Preferred Generic	3	001000	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			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	032	3	1	01	01	H3330_032_3	6	Generic	3	010000	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								20.00	40.00	60.00					16.00	32.00	48.00					16.00	32.00	48.00																20.00				20.00			0.67	0.53	0.53			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	032	3	1	01	01	H3330_032_3	6	Preferred Brand	3	000001	1	2	3	1		111	01	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	126.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	032	3	1	01	01	H3330_032_3	6	Non-Preferred Drug	3	110000	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31											222.76	25	25	25				204.94	23	23	23				23	23	23															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	032	3	1	01	01	H3330_032_3	6	Specialty Tier	3	010010	1	1	5	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31											711.60	25	25	25				711.60	25	25	25				25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	032	4	1	01	01	H3330_032_4	7	Preferred Generic	3	001000	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			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	032	4	1	01	01	H3330_032_4	7	Generic	3	010000	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								20.00	40.00	60.00					16.00	32.00	48.00					16.00	32.00	48.00																20.00				20.00			0.67	0.53	0.53			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	032	4	1	01	01	H3330_032_4	7	Preferred Brand	3	000001	1	2	3	1		111	01	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	126.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	032	4	1	01	01	H3330_032_4	7	Non-Preferred Drug	3	110000	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31											222.76	25	25	25				204.94	23	23	23				23	23	23															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	032	4	1	01	01	H3330_032_4	7	Specialty Tier	3	010010	1	1	5	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31											711.60	25	25	25				711.60	25	25	25				25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	033	1	1	01	01	H3330_033_1	5	Preferred Generic	3	001000	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			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	033	1	1	01	01	H3330_033_1	5	Generic	3	010000	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	30.00																20.00				20.00			0.67	0.33	0.33			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	033	1	1	01	01	H3330_033_1	5	Preferred Brand	3	000001	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			1.57	1.33	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	033	1	1	01	01	H3330_033_1	5	Non-Preferred Drug	3	110000	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31											163.21	25	25	25				150.16	23	23	23				23	23	23															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	033	1	1	01	01	H3330_033_1	5	Specialty Tier	3	010010	1	1	5	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31											478.05	25	25	25				478.05	25	25	25				25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	033	2	1	01	01	H3330_033_2	5	Preferred Generic	3	001000	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			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	033	2	1	01	01	H3330_033_2	5	Generic	3	010000	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	30.00																20.00				20.00			0.67	0.33	0.33			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	033	2	1	01	01	H3330_033_2	5	Preferred Brand	3	000001	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			1.57	1.33	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	033	2	1	01	01	H3330_033_2	5	Non-Preferred Drug	3	110000	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31											163.21	25	25	25				150.16	23	23	23				23	23	23															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	033	2	1	01	01	H3330_033_2	5	Specialty Tier	3	010010	1	1	5	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31											478.05	25	25	25				478.05	25	25	25				25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	033	3	1	01	01	H3330_033_3	6	Preferred Generic	3	001000	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			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	033	3	1	01	01	H3330_033_3	6	Generic	3	010000	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	30.00																20.00				20.00			0.67	0.33	0.33			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	033	3	1	01	01	H3330_033_3	6	Preferred Brand	3	000001	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			1.57	1.33	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	033	3	1	01	01	H3330_033_3	6	Non-Preferred Drug	3	110000	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31											163.21	25	25	25				150.16	23	23	23				23	23	23															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	033	3	1	01	01	H3330_033_3	6	Specialty Tier	3	010010	1	1	5	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31											478.05	25	25	25				478.05	25	25	25				25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	033	4	1	01	01	H3330_033_4	6	Preferred Generic	3	001000	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			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	033	4	1	01	01	H3330_033_4	6	Generic	3	010000	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	30.00																20.00				20.00			0.67	0.33	0.33			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	033	4	1	01	01	H3330_033_4	6	Preferred Brand	3	000001	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			1.57	1.33	1.33			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	033	4	1	01	01	H3330_033_4	6	Non-Preferred Drug	3	110000	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31											163.21	25	25	25				150.16	23	23	23				23	23	23															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	033	4	1	01	01	H3330_033_4	6	Specialty Tier	3	010010	1	1	5	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31											478.05	25	25	25				478.05	25	25	25				25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	036	0	1	01	01	H3330_036_0	7	Preferred Generic	3	001000	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			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	036	0	1	01	01	H3330_036_0	7	Generic	3	010000	1	2	2	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31								20.00	40.00	60.00					16.00	32.00	48.00					16.00	32.00	48.00																20.00				20.00			0.67	0.53	0.53			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	036	0	1	01	01	H3330_036_0	7	Preferred Brand	3	000001	1	2	3	1		111	01	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	126.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	036	0	1	01	01	H3330_036_0	7	Non-Preferred Drug	3	110000	1	1	4	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31											235.37	25	25	25				216.54	23	23	23				23	23	23															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3330	036	0	1	01	01	H3330_036_0	7	Specialty Tier	3	010010	1	1	5	1		111	01	111		1				30	60	90	2	2	30	60	90				30		31											767.39	25	25	25				767.39	25	25	25				25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	005	0	1	04	01	H3335_005_0	8	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	005	0	1	04	01	H3335_005_0	8	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	10.00		25.00																					25.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	005	0	1	04	01	H3335_005_0	8	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		117.50																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	005	0	1	04	01	H3335_005_0	8	Non-Preferred Drug	4	100100	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		250.00																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	005	0	1	04	01	H3335_005_0	8	Specialty Tier	4	010010	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31				1.00	33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	006	0	1	04	01	H3335_006_0	8	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	006	0	1	04	01	H3335_006_0	8	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	10.00		25.00																					25.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	006	0	1	04	01	H3335_006_0	8	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		117.50																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	006	0	1	04	01	H3335_006_0	8	Non-Preferred Drug	4	100100	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		250.00																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	006	0	1	04	01	H3335_006_0	8	Specialty Tier	4	010010	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31				1.00	33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	014	0	1	04	01	H3335_014_0	8	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	014	0	1	04	01	H3335_014_0	8	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	10.00		25.00																					25.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	014	0	1	04	01	H3335_014_0	8	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		117.50																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	014	0	1	04	01	H3335_014_0	8	Non-Preferred Drug	4	100100	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		250.00																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	014	0	1	04	01	H3335_014_0	8	Specialty Tier	4	010010	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31				1.00	33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	015	0	1	04	01	H3335_015_0	8	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	015	0	1	04	01	H3335_015_0	8	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	10.00		25.00																					25.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	015	0	1	04	01	H3335_015_0	8	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		117.50																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	015	0	1	04	01	H3335_015_0	8	Non-Preferred Drug	4	100100	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		250.00																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	015	0	1	04	01	H3335_015_0	8	Specialty Tier	4	010010	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31				1.00	33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	018	0	1	04	01	H3335_018_0	8	Preferred Generic	3	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	4.00		10.00																					10.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	018	0	1	04	01	H3335_018_0	8	Generic	3	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	20.00		50.00																					50.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	018	0	1	04	01	H3335_018_0	8	Preferred Brand	3	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	45.00		112.50																					112.50																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	018	0	1	04	01	H3335_018_0	8	Non-Preferred Drug	3	100100	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	95.00		237.50																					237.50																95.00				95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	018	0	1	04	01	H3335_018_0	8	Specialty Tier	3	010010	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31				1.00	26		26																				26															26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	038	0	1	04	01	H3335_038_0	8	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	038	0	1	04	01	H3335_038_0	8	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	10.00		25.00																					25.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	038	0	1	04	01	H3335_038_0	8	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		117.50																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	038	0	1	04	01	H3335_038_0	8	Non-Preferred Drug	4	100100	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		250.00																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	038	0	1	04	01	H3335_038_0	8	Specialty Tier	4	010010	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31				1.00	33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	051	0	1	04	01	H3335_051_0	8	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	051	0	1	04	01	H3335_051_0	8	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	10.00		25.00																					25.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	051	0	1	04	01	H3335_051_0	8	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		117.50																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	051	0	1	04	01	H3335_051_0	8	Non-Preferred Drug	4	100100	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		250.00																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	051	0	1	04	01	H3335_051_0	8	Specialty Tier	4	010010	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31				1.00	33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	053	0	1	04	01	H3335_053_0	8	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	053	0	1	04	01	H3335_053_0	8	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	14.00		35.00																					35.00																14.00				14.00		0.47						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	053	0	1	04	01	H3335_053_0	8	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		117.50																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	053	0	1	04	01	H3335_053_0	8	Non-Preferred Drug	4	100100	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		250.00																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	053	0	1	04	01	H3335_053_0	8	Specialty Tier	4	010010	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31				1.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	054	0	1	04	01	H3335_054_0	8	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	054	0	1	04	01	H3335_054_0	8	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	14.00		35.00																					35.00																14.00				14.00		0.47						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	054	0	1	04	01	H3335_054_0	8	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		117.50																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	054	0	1	04	01	H3335_054_0	8	Non-Preferred Drug	4	100100	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		250.00																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3335	054	0	1	04	01	H3335_054_0	8	Specialty Tier	4	010010	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31				1.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3337	001	0	1	01	01	H3337_001_0	7	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	1			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3337	001	0	1	01	01	H3337_001_0	7	Preferred Generic	4	001000	1	2	1	3	110		01	100		1	30		90				1	1			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3337	001	0	1	01	01	H3337_001_0	7	Generic	4	010000	3	2	2	1	110		01	100		1	30		90				1	1			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												
H3337	001	0	1	01	01	H3337_001_0	7	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				1	1			90				30		31	47.00		141.00																					141.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3337	001	0	1	01	01	H3337_001_0	7	Non-Preferred Drug	4	100100	3	1	4	1	110		01	100		1	30		90				1	1			90				30		31				61.01	30		30																				30															30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3337	001	0	1	01	01	H3337_001_0	7	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31				289.17	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3342	019	0	1	04	01	H3342_019_0	6	Preferred Generic	4	001000	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	019	0	1	04	01	H3342_019_0	6	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3342	019	0	1	04	01	H3342_019_0	6	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	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	019	0	1	04	01	H3342_019_0	6	Non-Preferred Drug	4	100100	1	2	4	1		111	01	111		1				30	60	90	1	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	019	0	1	04	01	H3342_019_0	6	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		34												27							27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3342	019	0	1	04	01	H3342_019_0	6	Select Care Drugs	4	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3342	019	0	1	04	01	H3342_019_0	6	Select Care Drugs	4	001000	1	2	6	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		
H3344	005	0	1	04	01	H3344_005_0	5	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				2	2			90				30		34	4.00		10.00																					10.00																4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3344	005	0	1	04	01	H3344_005_0	5	Generic	4	010000	1	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												
H3344	005	0	1	04	01	H3344_005_0	5	Preferred Brand	4	000001	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	005	0	1	04	01	H3344_005_0	5	Non-Preferred Drug	4	100100	1	1	4	1	110		01	100		1	30		90				2	2			90				30		34				99.12	45		45																				50															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3344	005	0	1	04	01	H3344_005_0	5	Specialty Tier	4	101101	1	1	5	1	010		01			1	30														30		34				726.74	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3347	013	0	1	02	01	H3347_013_0	13	Preferred Generic	4	001001	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												
H3347	013	0	1	02	01	H3347_013_0	13	Generic	4	010001	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												
H3347	013	0	1	02	01	H3347_013_0	13	Preferred Brand	4	000101	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3347	013	0	1	02	01	H3347_013_0	13	Non-Preferred Drug	4	100100	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3347	013	0	1	02	01	H3347_013_0	13	Specialty Tier	4	010010	1	1	5	1	111		01	100		1	30	60	90				1	2			90				30		31					33	33	33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	002	0	1	02	01	H3351_002_0	8	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	002	0	1	02	01	H3351_002_0	8	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	10.00		25.00																					25.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	002	0	1	02	01	H3351_002_0	8	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		117.50																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	002	0	1	02	01	H3351_002_0	8	Non-Preferred Drug	4	100100	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		250.00																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	002	0	1	02	01	H3351_002_0	8	Specialty Tier	4	010010	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31				1.00	33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	006	0	1	02	01	H3351_006_0	8	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	006	0	1	02	01	H3351_006_0	8	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	12.00		30.00																					30.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	006	0	1	02	01	H3351_006_0	8	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		117.50																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	006	0	1	02	01	H3351_006_0	8	Non-Preferred Drug	4	100100	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		250.00																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	006	0	1	02	01	H3351_006_0	8	Specialty Tier	4	010010	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31				1.00	33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	010	0	1	01	01	H3351_010_0	9	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	010	0	1	01	01	H3351_010_0	9	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	10.00		25.00																					25.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	010	0	1	01	01	H3351_010_0	9	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		117.50																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	010	0	1	01	01	H3351_010_0	9	Non-Preferred Drug	4	100100	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		250.00																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	010	0	1	01	01	H3351_010_0	9	Specialty Tier	4	010010	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31				1.00	33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	011	0	1	01	01	H3351_011_0	8	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	011	0	1	01	01	H3351_011_0	8	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	15.00		37.50																					37.50																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	011	0	1	01	01	H3351_011_0	8	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		117.50																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	011	0	1	01	01	H3351_011_0	8	Non-Preferred Drug	4	100100	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		250.00																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	011	0	1	01	01	H3351_011_0	8	Specialty Tier	4	010010	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31				1.00	28		28																				28															28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	012	0	1	01	01	H3351_012_0	8	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	012	0	1	01	01	H3351_012_0	8	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	10.00		25.00																					25.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	012	0	1	01	01	H3351_012_0	8	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		117.50																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	012	0	1	01	01	H3351_012_0	8	Non-Preferred Drug	4	100100	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		250.00																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	012	0	1	01	01	H3351_012_0	8	Specialty Tier	4	010010	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31				1.00	33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	013	0	1	01	01	H3351_013_0	8	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	013	0	1	01	01	H3351_013_0	8	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	15.00		37.50																					37.50																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	013	0	1	01	01	H3351_013_0	8	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		117.50																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	013	0	1	01	01	H3351_013_0	8	Non-Preferred Drug	4	100100	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		250.00																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	013	0	1	01	01	H3351_013_0	8	Specialty Tier	4	010010	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31				1.00	33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	015	0	1	02	01	H3351_015_0	8	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	4.00		10.00																					10.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	015	0	1	02	01	H3351_015_0	8	Generic	4	010000	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												
H3351	015	0	1	02	01	H3351_015_0	8	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	45.00		112.50																					112.50																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	015	0	1	02	01	H3351_015_0	8	Non-Preferred Drug	4	100100	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	95.00		237.50																					237.50																95.00				95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	015	0	1	02	01	H3351_015_0	8	Specialty Tier	4	010010	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31				1.00	33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	016	0	1	02	01	H3351_016_0	8	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	016	0	1	02	01	H3351_016_0	8	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	15.00		37.50																					37.50																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	016	0	1	02	01	H3351_016_0	8	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		117.50																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	016	0	1	02	01	H3351_016_0	8	Non-Preferred Drug	4	100100	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		250.00																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	016	0	1	02	01	H3351_016_0	8	Specialty Tier	4	010010	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31				1.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	017	0	1	01	01	H3351_017_0	8	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	017	0	1	01	01	H3351_017_0	8	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	14.00		35.00																					35.00																14.00				14.00		0.47						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	017	0	1	01	01	H3351_017_0	8	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		117.50																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	017	0	1	01	01	H3351_017_0	8	Non-Preferred Drug	4	100100	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		250.00																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3351	017	0	1	01	01	H3351_017_0	8	Specialty Tier	4	010010	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31				1.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3359	001	0	1	01	01	H3359_001_0	16	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3359	001	0	1	01	01	H3359_001_0	16	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	25.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3359	001	0	1	01	01	H3359_001_0	16	Preferred Brand	4	000001	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	100.00																40.00				40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3359	001	0	1	01	01	H3359_001_0	16	Non-Preferred Drug	4	100000	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	238.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3359	001	0	1	01	01	H3359_001_0	16	Specialty Tier	4	010010	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												
H3359	036	0	1	01	01	H3359_036_0	14	Generic	4	010000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3359	036	0	1	01	01	H3359_036_0	14	Preferred Brand	4	000001	1	2	2	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	100.00																40.00				40.00		1.33			1.33			1.29	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3359	036	0	1	01	01	H3359_036_0	14	Non-Preferred Brand	4	100000	1	2	3	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	225.00																90.00				90.00		3.00			3.00			2.90	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3359	036	0	1	01	01	H3359_036_0	14	Specialty Tier	4	010010	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31					33	33	33																		33	33	33															33			33								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3361	043	0	1	01	01	H3361_043_0	6	Preferred Generic	3	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3361	043	0	1	01	01	H3361_043_0	6	Generic	3	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		37.50				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3361	043	0	1	01	01	H3361_043_0	6	Preferred Brand	3	000101	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		112.50				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3361	043	0	1	01	01	H3361_043_0	6	Non-Preferred Drug	3	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				97.11	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3361	043	0	1	01	01	H3361_043_0	6	Specialty Tier	3	010010	1	1	5	1	010		01		010	1	30											30			30		31				2435.01	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3361	065	0	1	01	01	H3361_065_0	6	Preferred Generic	3	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3361	065	0	1	01	01	H3361_065_0	6	Generic	3	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		37.50				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3361	065	0	1	01	01	H3361_065_0	6	Preferred Brand	3	000101	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	44.00		132.00																									44.00		132.00				44.00		110.00				44.00				44.00		1.47				1.47	1.47	1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3361	065	0	1	01	01	H3361_065_0	6	Non-Preferred Drug	3	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				98.60	46		46																								46		46				46		46			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3361	065	0	1	01	01	H3361_065_0	6	Specialty Tier	3	010010	1	1	5	1	010		01		010	1	30											30			30		31				2341.70	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3361	099	0	1	01	01	H3361_099_0	6	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	3.00		9.00																									3.00		9.00				3.00		0.00				3.00				3.00		0.10				0.10	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3361	099	0	1	01	01	H3361_099_0	6	Generic	4	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		37.50				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3361	099	0	1	01	01	H3361_099_0	6	Preferred Brand	4	000101	1	2	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												
H3361	099	0	1	01	01	H3361_099_0	6	Non-Preferred Drug	4	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				83.88	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3361	099	0	1	01	01	H3361_099_0	6	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				2652.84	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3361	106	0	1	02	01	H3361_106_0	6	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3361	106	0	1	02	01	H3361_106_0	6	Generic	4	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		37.50				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3361	106	0	1	02	01	H3361_106_0	6	Preferred Brand	4	000101	1	2	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												
H3361	106	0	1	02	01	H3361_106_0	6	Non-Preferred Drug	4	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				78.50	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3361	106	0	1	02	01	H3361_106_0	6	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				2622.55	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3361	109	0	1	01	01	H3361_109_0	6	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3361	109	0	1	01	01	H3361_109_0	6	Generic	4	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		50.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3361	109	0	1	01	01	H3361_109_0	6	Preferred Brand	4	000101	1	2	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												
H3361	109	0	1	01	01	H3361_109_0	6	Non-Preferred Drug	4	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				98.36	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3361	109	0	1	01	01	H3361_109_0	6	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				2024.92	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3361	130	0	1	01	01	H3361_130_0	6	Preferred Generic	2	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	2.00		6.00																									2.00		6.00				2.00		0.00				2.00				2.00		0.07				0.07	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3361	130	0	1	01	01	H3361_130_0	6	Generic	2	010001	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		22.50				9.00				9.00		0.30				0.30	0.30	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3361	130	0	1	01	01	H3361_130_0	6	Preferred Brand	2	000101	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	36.00		108.00																									36.00		108.00				36.00		90.00				36.00				36.00		1.20				1.20	1.20	1.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3361	130	0	1	01	01	H3361_130_0	6	Non-Preferred Drug	2	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				98.75	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3361	130	0	1	01	01	H3361_130_0	6	Specialty Tier	2	010010	1	1	5	1	010		01		010	1	30											30			30		31				2287.72	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3361	132	0	1	01	01	H3361_132_0	6	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3361	132	0	1	01	01	H3361_132_0	6	Generic	4	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		37.50				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3361	132	0	1	01	01	H3361_132_0	6	Preferred Brand	4	000101	1	2	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												
H3361	132	0	1	01	01	H3361_132_0	6	Non-Preferred Drug	4	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				76.36	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3361	132	0	1	01	01	H3361_132_0	6	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				4217.99	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3361	133	0	1	01	01	H3361_133_0	6	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	4.00		12.00																									4.00		12.00				4.00		0.00				4.00				4.00		0.13				0.13	0.13	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3361	133	0	1	01	01	H3361_133_0	6	Generic	4	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		37.50				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3361	133	0	1	01	01	H3361_133_0	6	Preferred Brand	4	000101	1	2	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												
H3361	133	0	1	01	01	H3361_133_0	6	Non-Preferred Brand	4	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				83.36	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3361	133	0	1	01	01	H3361_133_0	6	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				3242.20	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3361	134	0	1	01	01	H3361_134_0	6	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3361	134	0	1	01	01	H3361_134_0	6	Generic	4	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		37.50				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3361	134	0	1	01	01	H3361_134_0	6	Preferred Brand	4	000101	1	2	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												
H3361	134	0	1	01	01	H3361_134_0	6	Non-Preferred Brand	4	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				87.34	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3361	134	0	1	01	01	H3361_134_0	6	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				2643.34	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3361	135	0	1	02	01	H3361_135_0	6	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3361	135	0	1	02	01	H3361_135_0	6	Generic	4	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		37.50				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3361	135	0	1	02	01	H3361_135_0	6	Preferred Brand	4	000101	1	2	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												
H3361	135	0	1	02	01	H3361_135_0	6	Non-Preferred Brand	4	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				76.64	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3361	135	0	1	02	01	H3361_135_0	6	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				2613.94	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	017	0	1	01	01	H3362_017_0	6	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				2	2			90				30		34	4.00		10.00																					10.00																4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	017	0	1	01	01	H3362_017_0	6	Generic	4	010000	1	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	6	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				2	2			90				30		34	47.00		117.50																					117.50																47.00				47.00		1.57						1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	017	0	1	01	01	H3362_017_0	6	Non-Preferred Drug	4	100100	1	1	4	1	110		01	100		1	30		90				2	2			90				30		34				91.79	50		50																				50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	017	0	1	01	01	H3362_017_0	6	Specialty Tier	4	101101	1	1	5	1	010		01			1	30														30		34				833.27	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	020	0	1	01	01	H3362_020_0	4	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				2	2			90				30		34	4.00		10.00																					10.00																4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	020	0	1	01	01	H3362_020_0	4	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				2	2			90				30		34	15.00		37.50																					37.50																15.00				15.00		0.50						0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	020	0	1	01	01	H3362_020_0	4	Preferred Brand	4	000001	1	1	3	1	110		01	100		1	30		90				2	2			90				30		34				79.13	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	020	0	1	01	01	H3362_020_0	4	Non-Preferred Drug	4	100100	1	1	4	1	110		01	100		1	30		90				2	2			90				30		34				44.62	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	020	0	1	01	01	H3362_020_0	4	Specialty Tier	4	101101	1	1	5	1	010		01			1	30														30		34				675.05	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	033	0	1	01	01	H3362_033_0	6	Preferred Generic	4	001000	1	2	1	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	033	0	1	01	01	H3362_033_0	6	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				2	2			90				30		34	20.00		50.00																					50.00																20.00				20.00		0.67						0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	033	0	1	01	01	H3362_033_0	6	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				2	2			90				30		34	47.00		117.50																					117.50																47.00				47.00		1.57						1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	033	0	1	01	01	H3362_033_0	6	Non-Preferred Drug	4	100100	1	1	4	1	110		01	100		1	30		90				2	2			90				30		34				98.33	48		48																				50															48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3362	033	0	1	01	01	H3362_033_0	6	Specialty Tier	4	101101	1	1	5	1	010		01			1	30														30		34				723.30	29																																					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3370	028	0	1	01	01	H3370_028_0	11	Preferred Generic	4	001000	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												
H3370	028	0	1	01	01	H3370_028_0	11	Generic	4	010000	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												
H3370	028	0	1	01	01	H3370_028_0	11	Preferred Brand	4	000101	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												
H3370	028	0	1	01	01	H3370_028_0	11	Non-Preferred Drug	4	100100	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												
H3370	028	0	1	01	01	H3370_028_0	11	Specialty Tier	4	010010	1	1	5	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												
H3370	028	0	1	01	01	H3370_028_0	11	Select Care Drugs	4	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3370	028	0	1	01	01	H3370_028_0	11	Select Care Drugs	4	001000	1	2	6	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		
H3370	029	1	1	01	01	H3370_029_1	9	Preferred Generic	4	001000	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												
H3370	029	1	1	01	01	H3370_029_1	9	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3370	029	1	1	01	01	H3370_029_1	9	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	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												
H3370	029	1	1	01	01	H3370_029_1	9	Non-Preferred Drug	4	100100	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												
H3370	029	1	1	01	01	H3370_029_1	9	Specialty Tier	4	010010	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												
H3370	029	1	1	01	01	H3370_029_1	9	Select Care Drugs	4	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3370	029	1	1	01	01	H3370_029_1	9	Select Care Drugs	4	001000	1	2	6	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		
H3370	029	2	1	01	01	H3370_029_2	10	Preferred Generic	4	001000	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												
H3370	029	2	1	01	01	H3370_029_2	10	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3370	029	2	1	01	01	H3370_029_2	10	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	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												
H3370	029	2	1	01	01	H3370_029_2	10	Non-Preferred Drug	4	100100	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												
H3370	029	2	1	01	01	H3370_029_2	10	Specialty Tier	4	010010	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												
H3370	029	2	1	01	01	H3370_029_2	10	Select Care Drugs	4	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3370	029	2	1	01	01	H3370_029_2	10	Select Care Drugs	4	001000	1	2	6	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		
H3370	029	3	1	01	01	H3370_029_3	8	Preferred Generic	4	001000	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												
H3370	029	3	1	01	01	H3370_029_3	8	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3370	029	3	1	01	01	H3370_029_3	8	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	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												
H3370	029	3	1	01	01	H3370_029_3	8	Non-Preferred Drug	4	100100	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												
H3370	029	3	1	01	01	H3370_029_3	8	Specialty Tier	4	010010	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												
H3370	029	3	1	01	01	H3370_029_3	8	Select Care Drugs	4	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3370	029	3	1	01	01	H3370_029_3	8	Select Care Drugs	4	001000	1	2	6	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		
H3370	030	0	1	01	01	H3370_030_0	7	Preferred Generic	3	001000	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												
H3370	030	0	1	01	01	H3370_030_0	7	Generic	3	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3370	030	0	1	01	01	H3370_030_0	7	Preferred Brand	3	000101	1	2	3	1		111	01	111		1				30	60	90	1	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												
H3370	030	0	1	01	01	H3370_030_0	7	Non-Preferred Drug	3	100100	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												
H3370	030	0	1	01	01	H3370_030_0	7	Specialty Tier	3	010010	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												
H3370	030	0	1	01	01	H3370_030_0	7	Select Care Drugs	3	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3370	031	0	1	01	01	H3370_031_0	7	Preferred Generic	4	001000	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												
H3370	031	0	1	01	01	H3370_031_0	7	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3370	031	0	1	01	01	H3370_031_0	7	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	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												
H3370	031	0	1	01	01	H3370_031_0	7	Non-Preferred Drug	4	100100	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												
H3370	031	0	1	01	01	H3370_031_0	7	Specialty Tier	4	010010	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												
H3370	031	0	1	01	01	H3370_031_0	7	Select Care Drugs	4	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3370	031	0	1	01	01	H3370_031_0	7	Select Care Drugs	4	001000	1	2	6	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		
H3370	032	0	1	01	01	H3370_032_0	8	Preferred Generic	4	001000	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												
H3370	032	0	1	01	01	H3370_032_0	8	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3370	032	0	1	01	01	H3370_032_0	8	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	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												
H3370	032	0	1	01	01	H3370_032_0	8	Non-Preferred Drug	4	100100	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												
H3370	032	0	1	01	01	H3370_032_0	8	Specialty Tier	4	010010	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												
H3370	032	0	1	01	01	H3370_032_0	8	Select Care Drugs	4	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3370	032	0	1	01	01	H3370_032_0	8	Select Care Drugs	4	001000	1	2	6	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		
H3370	035	0	1	01	01	H3370_035_0	7	Preferred Generic	4	001000	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												
H3370	035	0	1	01	01	H3370_035_0	7	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3370	035	0	1	01	01	H3370_035_0	7	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	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												
H3370	035	0	1	01	01	H3370_035_0	7	Non-Preferred Drug	4	100100	1	2	4	1		111	01	111		1				30	60	90	1	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												
H3370	035	0	1	01	01	H3370_035_0	7	Specialty Tier	4	010010	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												
H3370	035	0	1	01	01	H3370_035_0	7	Select Care Drugs	4	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3370	035	0	1	01	01	H3370_035_0	7	Select Care Drugs	4	001000	1	2	6	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		
H3370	038	0	1	02	01	H3370_038_0	9	Preferred Generic	4	001000	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												
H3370	038	0	1	02	01	H3370_038_0	9	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3370	038	0	1	02	01	H3370_038_0	9	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	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												
H3370	038	0	1	02	01	H3370_038_0	9	Non-Preferred Drug	4	100100	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												
H3370	038	0	1	02	01	H3370_038_0	9	Specialty Tier	4	010010	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												
H3370	038	0	1	02	01	H3370_038_0	9	Select Care Drugs	4	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3370	038	0	1	02	01	H3370_038_0	9	Select Care Drugs	4	001000	1	2	6	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		
H3370	039	0	1	02	01	H3370_039_0	9	Preferred Generic	4	001000	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												
H3370	039	0	1	02	01	H3370_039_0	9	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3370	039	0	1	02	01	H3370_039_0	9	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	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												
H3370	039	0	1	02	01	H3370_039_0	9	Non-Preferred Drug	4	100100	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												
H3370	039	0	1	02	01	H3370_039_0	9	Specialty Tier	4	010010	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												
H3370	039	0	1	02	01	H3370_039_0	9	Select Care Drugs	4	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3370	039	0	1	02	01	H3370_039_0	9	Select Care Drugs	4	001000	1	2	6	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		
H3379	001	0	1	01	01	H3379_001_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3379	001	0	1	01	01	H3379_001_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3379	001	0	1	01	01	H3379_001_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3379	001	0	1	01	01	H3379_001_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3379	001	0	1	01	01	H3379_001_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				796.00	26		26																										26						26			26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3379	039	0	1	01	01	H3379_039_0	4	Preferred Generic	3	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3379	039	0	1	01	01	H3379_039_0	4	Generic	3	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3379	039	0	1	01	01	H3379_039_0	4	Preferred Brand	3	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3379	039	0	1	01	01	H3379_039_0	4	Non-Preferred Drug	3	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3379	039	0	1	01	01	H3379_039_0	4	Specialty Tier	3	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				678.00	27		27																										27						27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	013	0	1	01	01	H3384_013_0	7	Preferred Generic	4	001000	1	2	1	1		110	10	110		1				30		90	1	2	30		90					29	31								10.00		30.00					5.00		15.00					5.00		12.50																	10.00			10.00			0.33	0.17	0.17			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	013	0	1	01	01	H3384_013_0	7	Preferred Generic	4	001000	1	2	1	3		110	10	110		1				30		90	1	2	30		90					29	31								10.00		30.00					5.00		15.00					5.00		12.50																	10.00			10.00			0.33	0.17	0.17			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3384	013	0	1	01	01	H3384_013_0	7	Generic	4	010000	1	2	2	1		110	10	110		1				30		90	1	2	30		90					29	31								20.00		60.00					15.00		45.00					15.00		37.50																	20.00			20.00			0.67	0.50	0.50			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	013	0	1	01	01	H3384_013_0	7	Preferred Brand	4	000001	1	2	3	1		110	10	110		1				30		90	1	2	30		90					29	31								47.00		141.00					42.00		126.00					42.00		105.00																	47.00			47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	013	0	1	01	01	H3384_013_0	7	Non-Preferred Drug	4	100100	1	2	4	1		110	10	110		1				30		90	1	2	30		90					29	31								100.00		300.00					94.00		282.00					94.00		235.00																	100.00			100.00			3.33	3.13	3.13			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	013	0	1	01	01	H3384_013_0	7	Specialty Tier	4	010010	1	1	5	1		110	10	110		1				30		90	1	2	30		90					29	31												33		33					33		33				33		33																33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	019	0	1	01	01	H3384_019_0	6	Preferred Generic	4	001000	1	2	1	1		110	10	110		1				30		90	1	2	30		90					29	31								12.00		36.00					7.00		21.00					7.00		17.50																	12.00			12.00			0.40	0.23	0.23			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	019	0	1	01	01	H3384_019_0	6	Preferred Generic	4	001000	1	2	1	3		110	10	110		1				30		90	1	2	30		90					29	31								12.00		36.00					7.00		21.00					7.00		17.50																	12.00			12.00			0.40	0.23	0.23			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3384	019	0	1	01	01	H3384_019_0	6	Generic	4	010000	1	2	2	1		110	10	110		1				30		90	1	2	30		90					29	31								20.00		60.00					15.00		45.00					15.00		37.50																	20.00			20.00			0.67	0.50	0.50			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	019	0	1	01	01	H3384_019_0	6	Preferred Brand	4	000001	1	2	3	1		110	10	110		1				30		90	1	2	30		90					29	31								47.00		141.00					42.00		126.00					42.00		105.00																	47.00			47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	019	0	1	01	01	H3384_019_0	6	Non-Preferred Drug	4	100100	1	2	4	1		110	10	110		1				30		90	1	2	30		90					29	31								100.00		300.00					94.00		282.00					94.00		235.00																	100.00			100.00			3.33	3.13	3.13			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	019	0	1	01	01	H3384_019_0	6	Specialty Tier	4	010010	1	1	5	1		110	10	110		1				30		90	1	2	30		90					29	31												33		33					33		33				33		33																33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	058	0	1	01	01	H3384_058_0	7	Preferred Generic	4	001000	1	2	1	1		110	10	110		1				30		90	1	2	30		90					29	31								15.00		45.00					10.00		30.00					10.00		25.00																	15.00			15.00			0.50	0.33	0.33			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	058	0	1	01	01	H3384_058_0	7	Generic	4	010000	1	2	2	1		110	10	110		1				30		90	1	2	30		90					29	31								20.00		60.00					15.00		45.00					15.00		37.50																	20.00			20.00			0.67	0.50	0.50			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	058	0	1	01	01	H3384_058_0	7	Preferred Brand	4	000001	1	2	3	1		110	10	110		1				30		90	1	2	30		90					29	31								47.00		141.00					42.00		126.00					42.00		105.00																	47.00			47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	058	0	1	01	01	H3384_058_0	7	Non-Preferred Drug	4	100100	1	2	4	1		110	10	110		1				30		90	1	2	30		90					29	31								100.00		300.00					94.00		282.00					94.00		235.00																	100.00			100.00			3.33	3.13	3.13			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	058	0	1	01	01	H3384_058_0	7	Specialty Tier	4	010010	1	1	5	1		110	10	110		1				30		90	1	2	30		90					29	31												33		33					33		33				33		33																33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	059	0	1	02	01	H3384_059_0	5	Preferred Generic	4	001000	1	2	1	1		110	10	110		1				30		90	1	2	30		90					29	31								15.00		45.00					10.00		30.00					10.00		25.00																	15.00			15.00			0.50	0.33	0.33			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	059	0	1	02	01	H3384_059_0	5	Generic	4	010000	1	2	2	1		110	10	110		1				30		90	1	2	30		90					29	31								20.00		60.00					15.00		45.00					15.00		37.50																	20.00			20.00			0.67	0.50	0.50			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	059	0	1	02	01	H3384_059_0	5	Preferred Brand	4	000001	1	2	3	1		110	10	110		1				30		90	1	2	30		90					29	31								47.00		141.00					42.00		126.00					42.00		105.00																	47.00			47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	059	0	1	02	01	H3384_059_0	5	Non-Preferred Drug	4	100100	1	2	4	1		110	10	110		1				30		90	1	2	30		90					29	31								100.00		300.00					94.00		282.00					94.00		235.00																	100.00			100.00			3.33	3.13	3.13			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3384	059	0	1	02	01	H3384_059_0	5	Specialty Tier	4	010010	1	1	5	1		110	10	110		1				30		90	1	2	30		90					29	31												33		33					33		33				33		33																33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3388	002	0	1	01	01	H3388_002_0	13	Preferred Generic	4	001000	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		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	Generic	4	010000	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	11.00		33.00																									11.00		33.00				11.00		22.00				11.00				11.00		0.36				0.37	0.37	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3388	002	0	1	01	01	H3388_002_0	13	Preferred Brand	4	010001	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	42.00		126.00																									42.00		126.00				42.00		84.00				42.00				42.00		1.40				1.40	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3388	002	0	1	01	01	H3388_002_0	13	Non-Preferred Drug	4	110000	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	90.00		270.00																									90.00		270.00				90.00		225.00				90.00				90.00		3.00				3.00	3.00	2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3388	002	0	1	01	01	H3388_002_0	13	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				728.87	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3388	004	0	1	01	01	H3388_004_0	9	Preferred Generic	4	001000	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	2.00		6.00																									2.00		6.00				2.00		4.00				2.00				2.00		0.06				0.07	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3388	004	0	1	01	01	H3388_004_0	9	Generic	4	010000	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	13.00		39.00																									13.00		39.00				13.00		26.00				13.00				13.00		0.43				0.43	0.43	0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3388	004	0	1	01	01	H3388_004_0	9	Preferred Brand	4	010001	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		90.00				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3388	004	0	1	01	01	H3388_004_0	9	Non-Preferred Drug	4	110000	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	97.00		291.00																									97.00		291.00				97.00		242.50				97.00				97.00		3.23				3.23	3.23	3.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3388	004	0	1	01	01	H3388_004_0	9	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				685.70	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3388	013	0	1	01	01	H3388_013_0	9	Preferred Generic	4	001000	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	3.00		9.00																									3.00		9.00				3.00		6.00				3.00				3.00		0.10				0.10	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3388	013	0	1	01	01	H3388_013_0	9	Generic	4	010000	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		30.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3388	013	0	1	01	01	H3388_013_0	9	Preferred Brand	4	010001	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3388	013	0	1	01	01	H3388_013_0	9	Non-Preferred Drug	4	110000	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		3.32				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3388	013	0	1	01	01	H3388_013_0	9	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				643.39	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3404	001	0	1	04	01	H3404_001_0	8	Preferred Generic	4	001000	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 Brand, Specialty Tier, Select Care Drugs												
H3404	001	0	1	04	01	H3404_001_0	8	Generic	4	010000	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 Brand, Specialty Tier, Select Care Drugs												
H3404	001	0	1	04	01	H3404_001_0	8	Preferred Brand	4	010001	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	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 Brand, Specialty Tier, Select Care Drugs												
H3404	001	0	1	04	01	H3404_001_0	8	Non-Preferred Brand	4	110000	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											67.42	50	50	50				67.42	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3404	001	0	1	04	01	H3404_001_0	8	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31											607.34	33						607.34	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3404	001	0	1	04	01	H3404_001_0	8	Select Care Drugs	4	010000	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3416	001	4	1	04	01	H3416_001_4	7	Preferred Generic	3	001000	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												
H3416	001	4	1	04	01	H3416_001_4	7	Generic	3	010000	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		40.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3416	001	4	1	04	01	H3416_001_4	7	Preferred Brand	3	010001	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3416	001	4	1	04	01	H3416_001_4	7	Non-Preferred Drug	3	100100	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3416	001	4	1	04	01	H3416_001_4	7	Specialty Tier	3	010010	1	1	5	1	010		01		010	1	30											30			30		31					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3416	001	5	1	04	01	H3416_001_5	5	Preferred Generic	3	001000	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												
H3416	001	5	1	04	01	H3416_001_5	5	Generic	3	010000	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		40.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3416	001	5	1	04	01	H3416_001_5	5	Preferred Brand	3	010001	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3416	001	5	1	04	01	H3416_001_5	5	Non-Preferred Drug	3	100100	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3416	001	5	1	04	01	H3416_001_5	5	Specialty Tier	3	010010	1	1	5	1	010		01		010	1	30											30			30		31					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3416	002	2	1	04	01	H3416_002_2	5	Preferred Generic	4	001000	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												
H3416	002	2	1	04	01	H3416_002_2	5	Preferred Generic	4	001000	1	2	1	3	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										1		
H3416	002	2	1	04	01	H3416_002_2	5	Generic	4	010000	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		40.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3416	002	2	1	04	01	H3416_002_2	5	Generic	4	010000	1	2	2	3	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		40.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3416	002	2	1	04	01	H3416_002_2	5	Preferred Brand	4	010001	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3416	002	2	1	04	01	H3416_002_2	5	Non-Preferred Drug	4	100100	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3416	002	2	1	04	01	H3416_002_2	5	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31					29																										29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3416	002	3	1	04	01	H3416_002_3	4	Preferred Generic	4	001000	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												
H3416	002	3	1	04	01	H3416_002_3	4	Preferred Generic	4	001000	1	2	1	3	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										1		
H3416	002	3	1	04	01	H3416_002_3	4	Generic	4	010000	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		40.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3416	002	3	1	04	01	H3416_002_3	4	Generic	4	010000	1	2	2	3	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		40.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3416	002	3	1	04	01	H3416_002_3	4	Preferred Brand	4	010001	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3416	002	3	1	04	01	H3416_002_3	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	100.00		300.00																									100.00		300.00				100.00		200.00				100.00				100.00		3.33				3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3416	002	3	1	04	01	H3416_002_3	4	Specialty Tier	4	010010	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												
H3447	001	0	1	01	01	H3447_001_0	6	Preferred Generic	4	001000	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	001	0	1	01	01	H3447_001_0	6	Preferred Generic	4	001000	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3447	001	0	1	01	01	H3447_001_0	6	Generic	4	010000	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								12.50		37.50					7.50		22.50							18.75																12.50				12.50			0.42	0.25				0.40	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	001	0	1	01	01	H3447_001_0	6	Generic	4	010000	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								12.50		37.50					7.50		22.50							18.75																12.50				12.50			0.42	0.25				0.40	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3447	001	0	1	01	01	H3447_001_0	6	Preferred Brand	4	000001	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								45.00		135.00					40.00		120.00							100.00																45.00				45.00			1.50	1.33				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	001	0	1	01	01	H3447_001_0	6	Non-Preferred Drug	4	100100	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								95.00		285.00					85.00		255.00							212.50																95.00				95.00			3.17	2.83				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	001	0	1	01	01	H3447_001_0	6	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		31											538.00	33						538.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	001	0	1	01	01	H3447_001_0	6	Select Care Drugs	4	010010	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	001	0	1	01	01	H3447_001_0	6	Select Care Drugs	4	010010	1	2	6	3		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H3447	003	0	1	01	01	H3447_003_0	6	Preferred Generic	4	001000	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	003	0	1	01	01	H3447_003_0	6	Preferred Generic	4	001000	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3447	003	0	1	01	01	H3447_003_0	6	Generic	4	010000	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								12.50		37.50					7.50		22.50							18.75																12.50				12.50			0.42	0.25				0.40	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	003	0	1	01	01	H3447_003_0	6	Generic	4	010000	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								12.50		37.50					7.50		22.50							18.75																12.50				12.50			0.42	0.25				0.40	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3447	003	0	1	01	01	H3447_003_0	6	Preferred Brand	4	000001	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								45.00		135.00					40.00		120.00							100.00																45.00				45.00			1.50	1.33				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	003	0	1	01	01	H3447_003_0	6	Non-Preferred Drug	4	100100	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								95.00		285.00					85.00		255.00							212.50																95.00				95.00			3.17	2.83				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	003	0	1	01	01	H3447_003_0	6	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		31											538.00	33						538.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	003	0	1	01	01	H3447_003_0	6	Select Care Drugs	4	010010	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	003	0	1	01	01	H3447_003_0	6	Select Care Drugs	4	010010	1	2	6	3		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H3447	004	0	1	01	01	H3447_004_0	6	Preferred Generic	4	001000	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	004	0	1	01	01	H3447_004_0	6	Preferred Generic	4	001000	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3447	004	0	1	01	01	H3447_004_0	6	Generic	4	010000	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								12.50		37.50					7.50		22.50							18.75																12.50				12.50			0.42	0.25				0.40	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	004	0	1	01	01	H3447_004_0	6	Generic	4	010000	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								12.50		37.50					7.50		22.50							18.75																12.50				12.50			0.42	0.25				0.40	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3447	004	0	1	01	01	H3447_004_0	6	Preferred Brand	4	000001	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								45.00		135.00					40.00		120.00							100.00																45.00				45.00			1.50	1.33				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	004	0	1	01	01	H3447_004_0	6	Non-Preferred Drug	4	100100	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								95.00		285.00					85.00		255.00							212.50																95.00				95.00			3.17	2.83				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	004	0	1	01	01	H3447_004_0	6	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		31											538.00	33						538.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	004	0	1	01	01	H3447_004_0	6	Select Care Drugs	4	010010	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	004	0	1	01	01	H3447_004_0	6	Select Care Drugs	4	010010	1	2	6	3		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H3447	005	0	1	01	01	H3447_005_0	7	Preferred Generic	4	001000	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								10.00		30.00					5.00		15.00							12.50																10.00				10.00			0.33	0.17				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	005	0	1	01	01	H3447_005_0	7	Generic	4	010000	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								15.50		46.50					10.50		31.50							26.25																15.50				15.50			0.52	0.35				0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	005	0	1	01	01	H3447_005_0	7	Preferred Brand	4	000001	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								45.00		135.00					40.00		120.00							100.00																45.00				45.00			1.50	1.33				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	005	0	1	01	01	H3447_005_0	7	Non-Preferred Drug	4	100100	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								95.00		285.00					90.00		270.00							225.00																95.00				95.00			3.17	3.00				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	005	0	1	01	01	H3447_005_0	7	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		31											538.00	33						538.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	005	0	1	01	01	H3447_005_0	7	Select Care Drugs	4	010010	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								10.00		30.00					10.00		30.00							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												
H3447	010	0	1	01	01	H3447_010_0	6	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	010	0	1	01	01	H3447_010_0	6	Preferred Generic	4	001000	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3447	010	0	1	01	01	H3447_010_0	6	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	7.50		22.50																					18.75																7.50				7.50		0.25						0.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	010	0	1	01	01	H3447_010_0	6	Generic	4	010000	1	2	2	3	110		01	100		1	30		90				1	2			90				30		31	7.50		22.50																					18.75																7.50				7.50		0.25						0.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3447	010	0	1	01	01	H3447_010_0	6	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	40.00		120.00																					100.00																40.00				40.00		1.33						1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	010	0	1	01	01	H3447_010_0	6	Non-Preferred Drug	4	100100	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	85.00		255.00																					212.50																85.00				85.00		2.83						2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	010	0	1	01	01	H3447_010_0	6	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31				538.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	010	0	1	01	01	H3447_010_0	6	Select Care Drugs	4	010010	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	010	0	1	01	01	H3447_010_0	6	Select Care Drugs	4	010010	1	2	6	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H3447	011	0	1	01	01	H3447_011_0	8	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	011	0	1	01	01	H3447_011_0	8	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								11.00	22.00	33.00					11.00	22.00	33.00					11.00	33.00	33.00																11.00				11.00			0.37	0.37	0.37			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	011	0	1	01	01	H3447_011_0	8	Preferred Brand	4	000101	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												
H3447	011	0	1	01	01	H3447_011_0	8	Non-Preferred Drug	4	100100	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												
H3447	011	0	1	01	01	H3447_011_0	8	Specialty Tier	4	010010	1	1	5	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	8	Select Care Drugs	4	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	011	0	1	01	01	H3447_011_0	8	Select Care Drugs	4	001000	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3447	012	0	1	01	01	H3447_012_0	8	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	012	0	1	01	01	H3447_012_0	8	Generic	4	010000	1	2	2	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	012	0	1	01	01	H3447_012_0	8	Preferred Brand	4	000101	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												
H3447	012	0	1	01	01	H3447_012_0	8	Non-Preferred Drug	4	100100	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												
H3447	012	0	1	01	01	H3447_012_0	8	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	012	0	1	01	01	H3447_012_0	8	Select Care Drugs	4	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3447	012	0	1	01	01	H3447_012_0	8	Select Care Drugs	4	001000	1	2	6	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		
H3449	005	0	1	01	01	H3449_005_0	7	Preferred Generic	4	001000	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 Brand, Specialty Tier, Select Care Drugs												
H3449	005	0	1	01	01	H3449_005_0	7	Preferred Generic	4	001000	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 Brand, Specialty Tier, Select Care Drugs										1		
H3449	005	0	1	01	01	H3449_005_0	7	Generic	4	010000	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 Brand, Specialty Tier, Select Care Drugs												
H3449	005	0	1	01	01	H3449_005_0	7	Preferred Brand	4	010001	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	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 Brand, Specialty Tier, Select Care Drugs												
H3449	005	0	1	01	01	H3449_005_0	7	Non-Preferred Brand	4	110000	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											68.67	50	50	50				68.67	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3449	005	0	1	01	01	H3449_005_0	7	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31											500.17	33						500.17	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3449	005	0	1	01	01	H3449_005_0	7	Select Care Drugs	4	010000	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3449	016	0	1	01	01	H3449_016_0	8	Preferred Generic	3	001000	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 Brand, Specialty Tier												
H3449	016	0	1	01	01	H3449_016_0	8	Generic	3	010000	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 Brand, Specialty Tier												
H3449	016	0	1	01	01	H3449_016_0	8	Preferred Brand	3	010001	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	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 Brand, Specialty Tier												
H3449	016	0	1	01	01	H3449_016_0	8	Non-Preferred Brand	3	110000	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											75.32	50	50	50				75.32	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3449	016	0	1	01	01	H3449_016_0	8	Specialty Tier	3	010010	1	1	5	1		010	01		010	1				30								30			30		31											351.62	25						351.62	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3449	023	1	1	01	01	H3449_023_1	8	Preferred Generic	4	001000	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 Brand, Specialty Tier												
H3449	023	1	1	01	01	H3449_023_1	8	Generic	4	010000	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 Brand, Specialty Tier												
H3449	023	1	1	01	01	H3449_023_1	8	Preferred Brand	4	010001	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	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 Brand, Specialty Tier												
H3449	023	1	1	01	01	H3449_023_1	8	Non-Preferred Brand	4	110000	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											80.83	50	50	50				80.83	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3449	023	1	1	01	01	H3449_023_1	8	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31											401.65	25						401.65	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3449	023	2	1	01	01	H3449_023_2	8	Preferred Generic	4	001000	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 Brand, Specialty Tier												
H3449	023	2	1	01	01	H3449_023_2	8	Generic	4	010000	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 Brand, Specialty Tier												
H3449	023	2	1	01	01	H3449_023_2	8	Preferred Brand	4	010001	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	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 Brand, Specialty Tier												
H3449	023	2	1	01	01	H3449_023_2	8	Non-Preferred Brand	4	110000	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											80.83	50	50	50				80.83	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3449	023	2	1	01	01	H3449_023_2	8	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31											401.65	25						401.65	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3471	001	0	1	01	01	H3471_001_0	5	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	22.50					0.00	0.00	0.00					9.00	18.00	22.50																9.00				9.00			0.30	0.00	0.30			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	001	0	1	01	01	H3471_001_0	5	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	50.00					20.00	40.00	40.00					20.00	40.00	50.00																20.00				20.00			0.67	0.67	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	001	0	1	01	01	H3471_001_0	5	Preferred Brand	4	000001	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	117.50					47.00	94.00	94.00					47.00	94.00	117.50																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	001	0	1	01	01	H3471_001_0	5	Non-Preferred Drug	4	100100	1	1	4	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	001	0	1	01	01	H3471_001_0	5	Specialty Tier	4	010010	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	002	0	1	01	01	H3471_002_0	5	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	22.50					0.00	0.00	0.00					9.00	18.00	22.50																9.00				9.00			0.30	0.00	0.30			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	002	0	1	01	01	H3471_002_0	5	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	50.00					20.00	40.00	40.00					20.00	40.00	50.00																20.00				20.00			0.67	0.67	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	002	0	1	01	01	H3471_002_0	5	Preferred Brand	4	000001	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	117.50					47.00	94.00	94.00					47.00	94.00	117.50																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	002	0	1	01	01	H3471_002_0	5	Non-Preferred Drug	4	100100	1	1	4	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	002	0	1	01	01	H3471_002_0	5	Specialty Tier	4	010010	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	004	0	1	01	01	H3471_004_0	5	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	22.50					0.00	0.00	0.00					9.00	18.00	22.50																9.00				9.00			0.30	0.00	0.30			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	004	0	1	01	01	H3471_004_0	5	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	50.00					20.00	40.00	40.00					20.00	40.00	50.00																20.00				20.00			0.67	0.67	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	004	0	1	01	01	H3471_004_0	5	Preferred Brand	4	000001	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	117.50					47.00	94.00	94.00					47.00	94.00	117.50																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	004	0	1	01	01	H3471_004_0	5	Non-Preferred Drug	4	100100	1	1	4	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	004	0	1	01	01	H3471_004_0	5	Specialty Tier	4	010010	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	005	0	1	01	01	H3471_005_0	5	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	22.50					0.00	0.00	0.00					9.00	18.00	22.50																9.00				9.00			0.30	0.00	0.30			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	005	0	1	01	01	H3471_005_0	5	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	50.00					20.00	40.00	40.00					20.00	40.00	50.00																20.00				20.00			0.67	0.67	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	005	0	1	01	01	H3471_005_0	5	Preferred Brand	4	000001	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	117.50					47.00	94.00	94.00					47.00	94.00	117.50																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	005	0	1	01	01	H3471_005_0	5	Non-Preferred Drug	4	100100	1	1	4	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	005	0	1	01	01	H3471_005_0	5	Specialty Tier	4	010010	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	007	0	1	01	01	H3471_007_0	5	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	22.50					0.00	0.00	0.00					9.00	18.00	22.50																9.00				9.00			0.30	0.00	0.30			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	007	0	1	01	01	H3471_007_0	5	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	50.00					20.00	40.00	40.00					20.00	40.00	50.00																20.00				20.00			0.67	0.67	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	007	0	1	01	01	H3471_007_0	5	Preferred Brand	4	000001	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	117.50					47.00	94.00	94.00					47.00	94.00	117.50																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	007	0	1	01	01	H3471_007_0	5	Non-Preferred Drug	4	100100	1	1	4	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	007	0	1	01	01	H3471_007_0	5	Specialty Tier	4	010010	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	008	0	1	01	01	H3471_008_0	5	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	22.50					0.00	0.00	0.00					9.00	18.00	22.50																9.00				9.00			0.30	0.00	0.30			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	008	0	1	01	01	H3471_008_0	5	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	50.00					20.00	40.00	40.00					20.00	40.00	50.00																20.00				20.00			0.67	0.67	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	008	0	1	01	01	H3471_008_0	5	Preferred Brand	4	000001	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	117.50					47.00	94.00	94.00					47.00	94.00	117.50																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	008	0	1	01	01	H3471_008_0	5	Non-Preferred Drug	4	100100	1	1	4	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	008	0	1	01	01	H3471_008_0	5	Specialty Tier	4	010010	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	010	0	1	01	01	H3471_010_0	7	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	22.50					0.00	0.00	0.00					9.00	18.00	22.50																9.00				9.00			0.30	0.00	0.30			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	010	0	1	01	01	H3471_010_0	7	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	50.00					20.00	40.00	40.00					20.00	40.00	50.00																20.00				20.00			0.67	0.67	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	010	0	1	01	01	H3471_010_0	7	Preferred Brand	4	000001	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	117.50					47.00	94.00	94.00					47.00	94.00	117.50																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	010	0	1	01	01	H3471_010_0	7	Non-Preferred Drug	4	100100	1	1	4	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	010	0	1	01	01	H3471_010_0	7	Specialty Tier	4	010010	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	012	0	1	01	01	H3471_012_0	7	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	22.50					0.00	0.00	0.00					9.00	18.00	22.50																9.00				9.00			0.30	0.00	0.30			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	012	0	1	01	01	H3471_012_0	7	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	50.00					20.00	40.00	40.00					20.00	40.00	50.00																20.00				20.00			0.67	0.67	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	012	0	1	01	01	H3471_012_0	7	Preferred Brand	4	000001	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	117.50					47.00	94.00	94.00					47.00	94.00	117.50																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	012	0	1	01	01	H3471_012_0	7	Non-Preferred Drug	4	100100	1	1	4	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	012	0	1	01	01	H3471_012_0	7	Specialty Tier	4	010010	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	013	0	1	02	01	H3471_013_0	5	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	22.50					0.00	0.00	0.00					9.00	18.00	22.50																9.00				9.00			0.30	0.00	0.30			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	013	0	1	02	01	H3471_013_0	5	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	50.00					20.00	40.00	40.00					20.00	40.00	50.00																20.00				20.00			0.67	0.67	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	013	0	1	02	01	H3471_013_0	5	Preferred Brand	4	000001	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	117.50					47.00	94.00	94.00					47.00	94.00	117.50																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	013	0	1	02	01	H3471_013_0	5	Non-Preferred Drug	4	100100	1	1	4	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	013	0	1	02	01	H3471_013_0	5	Specialty Tier	4	010010	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	014	0	1	02	01	H3471_014_0	5	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	22.50					0.00	0.00	0.00					9.00	18.00	22.50																9.00				9.00			0.30	0.00	0.30			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	014	0	1	02	01	H3471_014_0	5	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	50.00					20.00	40.00	40.00					20.00	40.00	50.00																20.00				20.00			0.67	0.67	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	014	0	1	02	01	H3471_014_0	5	Preferred Brand	4	000001	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	117.50					47.00	94.00	94.00					47.00	94.00	117.50																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	014	0	1	02	01	H3471_014_0	5	Non-Preferred Drug	4	100100	1	1	4	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3471	014	0	1	02	01	H3471_014_0	5	Specialty Tier	4	010010	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								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3480	001	0	1	48	05	H3480_001_0	5	Generic Drugs	4	010000			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	3.30	0.00	3.30	0.00	3.30	0.00	3.30			
H3480	001	0	1	48	05	H3480_001_0	5	Brand Drugs	4	000010			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	8.25	0.00	8.25	0.00	8.25	0.00	8.25			
H3480	001	0	1	48	05	H3480_001_0	5	Non-Medicare Rx Drugs	4	010010			3	1	110		01	110		1	30		90				1	2	30		90				30		31																																														0.00			0.00			0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H3480	001	0	1	48	05	H3480_001_0	5	Non-Medicare OTC Drugs	4	010010			4	1	110		01	110		1	30		90				1	2	30		90				30		31																																														0.00			0.00			0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H3528	001	0	1	02	01	H3528_001_0	7	Preferred Generic	4	001000	1	2	1	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	12.00					4.00	8.00	8.00																9.00				9.00			0.30	0.13	0.13			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	001	0	1	02	01	H3528_001_0	7	Generic	4	010000	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	30.00																20.00				20.00			0.67	0.50	0.50			.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	001	0	1	02	01	H3528_001_0	7	Preferred Brand	4	000001	1	2	3	1		111	01	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				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	001	0	1	02	01	H3528_001_0	7	Non-Preferred Drug	4	110000	1	2	4	1		111	01	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	238.00																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	001	0	1	02	01	H3528_001_0	7	Specialty Tier	4	010010	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												
H3528	002	0	1	01	01	H3528_002_0	7	Preferred Generic	4	001000	1	2	1	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	12.00					4.00	8.00	8.00																9.00				9.00			0.30	0.13	0.13			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	002	0	1	01	01	H3528_002_0	7	Preferred Generic	4	001000	1	2	1	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	12.00					4.00	8.00	8.00																9.00				9.00			0.30	0.13	0.13			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3528	002	0	1	01	01	H3528_002_0	7	Generic	4	010000	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	30.00																20.00				20.00			0.67	0.50	0.50			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	002	0	1	01	01	H3528_002_0	7	Generic	4	010000	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		31								20.00	40.00	60.00					15.00	30.00	45.00					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										1		
H3528	002	0	1	01	01	H3528_002_0	7	Preferred Brand	4	000001	1	2	3	1		111	01	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				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	002	0	1	01	01	H3528_002_0	7	Non-Preferred Drug	4	110000	1	2	4	1		111	01	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	238.00																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	002	0	1	01	01	H3528_002_0	7	Specialty Tier	4	010010	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												
H3528	006	0	1	02	01	H3528_006_0	7	Preferred Generic	4	001000	1	2	1	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	12.00					4.00	8.00	8.00																9.00				9.00			0.30	0.13	0.13			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	006	0	1	02	01	H3528_006_0	7	Preferred Generic	4	001000	1	2	1	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	12.00					4.00	8.00	8.00																9.00				9.00			0.30	0.13	0.13			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3528	006	0	1	02	01	H3528_006_0	7	Generic	4	010000	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	30.00																20.00				20.00			0.67	0.50	0.50			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	006	0	1	02	01	H3528_006_0	7	Generic	4	010000	1	2	2	3		111	01	111		1				30	60	90	2	2	30	60	90				30		31								20.00	40.00	60.00					15.00	30.00	45.00					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										1		
H3528	006	0	1	02	01	H3528_006_0	7	Preferred Brand	4	000001	1	2	3	1		111	01	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				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	006	0	1	02	01	H3528_006_0	7	Non-Preferred Drug	4	110000	1	2	4	1		111	01	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	238.00																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	006	0	1	02	01	H3528_006_0	7	Specialty Tier	4	010010	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												
H3528	008	0	1	02	01	H3528_008_0	8	Preferred Generic	4	001000	1	2	1	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	12.00					4.00	8.00	8.00																9.00				9.00			0.30	0.13	0.13			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	008	0	1	02	01	H3528_008_0	8	Generic	4	010000	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	30.00																20.00				20.00			0.67	0.50	0.50			.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	008	0	1	02	01	H3528_008_0	8	Preferred Brand	4	000001	1	2	3	1		111	01	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				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	008	0	1	02	01	H3528_008_0	8	Non-Preferred Drug	4	110000	1	2	4	1		111	01	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	238.00																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	008	0	1	02	01	H3528_008_0	8	Specialty Tier	4	010010	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												
H3528	010	0	1	01	01	H3528_010_0	7	Preferred Generic	4	001000	1	2	1	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	12.00					4.00	8.00	8.00																9.00				9.00			0.30	0.13	0.13			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	010	0	1	01	01	H3528_010_0	7	Generic	4	010000	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	30.00																20.00				20.00			0.67	0.50	0.50			.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	010	0	1	01	01	H3528_010_0	7	Preferred Brand	4	000001	1	2	3	1		111	01	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				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	010	0	1	01	01	H3528_010_0	7	Non-Preferred Drug	4	110000	1	2	4	1		111	01	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	238.00																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3528	010	0	1	01	01	H3528_010_0	7	Specialty Tier	4	010010	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												
H3533	001	0	1	01	01	H3533_001_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	001	0	1	01	01	H3533_001_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H3533	001	0	1	01	01	H3533_001_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	001	0	1	01	01	H3533_001_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H3533	001	0	1	01	01	H3533_001_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	001	0	1	01	01	H3533_001_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H3533	001	0	1	01	01	H3533_001_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	001	0	1	01	01	H3533_001_0	4	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H3533	001	0	1	01	01	H3533_001_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	001	0	1	01	01	H3533_001_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H3533	002	0	1	01	01	H3533_002_0	4	Preferred Generic	3	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	002	0	1	01	01	H3533_002_0	4	Generic	3	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								15.00		45.00					10.00		30.00											15.00		45.00				10.00		0.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	002	0	1	01	01	H3533_002_0	4	Preferred Brand	3	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	002	0	1	01	01	H3533_002_0	4	Non-Preferred Drug	3	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	002	0	1	01	01	H3533_002_0	4	Specialty Tier	3	010010	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	004	0	1	01	01	H3533_004_0	4	Preferred Generic	3	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	004	0	1	01	01	H3533_004_0	4	Generic	3	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					19.00		57.00											20.00		60.00				19.00		0.00				20.00				20.00			0.67	0.63		0.67	0.63	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	004	0	1	01	01	H3533_004_0	4	Preferred Brand	3	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	004	0	1	01	01	H3533_004_0	4	Non-Preferred Drug	3	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	004	0	1	01	01	H3533_004_0	4	Specialty Tier	3	010010	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	006	0	1	01	01	H3533_006_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					8.00		24.00											10.00		30.00				8.00		0.00				10.00				10.00			0.33	0.27		0.33	0.27	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	006	0	1	01	01	H3533_006_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					8.00		24.00											10.00		30.00				8.00		0.00				10.00				10.00			0.33	0.27		0.33	0.27	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H3533	006	0	1	01	01	H3533_006_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	006	0	1	01	01	H3533_006_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H3533	006	0	1	01	01	H3533_006_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	006	0	1	01	01	H3533_006_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H3533	006	0	1	01	01	H3533_006_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	006	0	1	01	01	H3533_006_0	4	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H3533	006	0	1	01	01	H3533_006_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	006	0	1	01	01	H3533_006_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H3533	010	0	1	01	01	H3533_010_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								11.00		33.00					10.00		30.00											11.00		33.00				10.00		0.00				11.00				11.00			0.37	0.33		0.37	0.33	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	010	0	1	01	01	H3533_010_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								11.00		33.00					10.00		30.00											11.00		33.00				10.00		0.00				11.00				11.00			0.37	0.33		0.37	0.33	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H3533	010	0	1	01	01	H3533_010_0	3	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	010	0	1	01	01	H3533_010_0	3	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H3533	010	0	1	01	01	H3533_010_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	010	0	1	01	01	H3533_010_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H3533	010	0	1	01	01	H3533_010_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	010	0	1	01	01	H3533_010_0	3	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H3533	010	0	1	01	01	H3533_010_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	010	0	1	01	01	H3533_010_0	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H3533	013	0	1	01	01	H3533_013_0	4	Preferred Generic	3	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								6.00		18.00					4.00		12.00											6.00		18.00				4.00		0.00				6.00				6.00			0.20	0.13		0.20	0.13	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	013	0	1	01	01	H3533_013_0	4	Generic	3	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					14.00		42.00											20.00		60.00				14.00		0.00				20.00				20.00			0.67	0.47		0.67	0.47	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	013	0	1	01	01	H3533_013_0	4	Preferred Brand	3	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	013	0	1	01	01	H3533_013_0	4	Non-Preferred Drug	3	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	013	0	1	01	01	H3533_013_0	4	Specialty Tier	3	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	020	0	1	01	01	H3533_020_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					9.00		27.00											10.00		30.00				9.00		0.00				10.00				10.00			0.33	0.30		0.33	0.30	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	020	0	1	01	01	H3533_020_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					9.00		27.00											10.00		30.00				9.00		0.00				10.00				10.00			0.33	0.30		0.33	0.30	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H3533	020	0	1	01	01	H3533_020_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	020	0	1	01	01	H3533_020_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H3533	020	0	1	01	01	H3533_020_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	020	0	1	01	01	H3533_020_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H3533	020	0	1	01	01	H3533_020_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	020	0	1	01	01	H3533_020_0	4	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H3533	020	0	1	01	01	H3533_020_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	020	0	1	01	01	H3533_020_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H3533	021	0	1	01	01	H3533_021_0	5	Preferred Generic	3	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					8.00		24.00											10.00		30.00				8.00		0.00				10.00				10.00			0.33	0.27		0.33	0.27	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	021	0	1	01	01	H3533_021_0	5	Generic	3	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					18.00		54.00											20.00		60.00				18.00		0.00				20.00				20.00			0.67	0.60		0.67	0.60	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	021	0	1	01	01	H3533_021_0	5	Preferred Brand	3	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	021	0	1	01	01	H3533_021_0	5	Non-Preferred Drug	3	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3533	021	0	1	01	01	H3533_021_0	5	Specialty Tier	3	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3536	002	0	1	01	01	H3536_002_0	9	Preferred Generic	4	001000	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	002	0	1	01	01	H3536_002_0	9	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	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	002	0	1	01	01	H3536_002_0	9	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	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												
H3536	002	0	1	01	01	H3536_002_0	9	Non-Preferred Drug	4	100100	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												
H3536	002	0	1	01	01	H3536_002_0	9	Specialty Tier	4	010010	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	9	Select Care Drugs	4	000001	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			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	9	Select Care Drugs	4	000001	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3536	003	0	1	01	01	H3536_003_0	6	Preferred Generic	4	001000	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	003	0	1	01	01	H3536_003_0	6	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	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	003	0	1	01	01	H3536_003_0	6	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	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												
H3536	003	0	1	01	01	H3536_003_0	6	Non-Preferred Drug	4	100100	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												
H3536	003	0	1	01	01	H3536_003_0	6	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		34												29							29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3536	003	0	1	01	01	H3536_003_0	6	Select Care Drugs	4	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3536	003	0	1	01	01	H3536_003_0	6	Select Care Drugs	4	001000	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3536	004	0	1	01	01	H3536_004_0	9	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3536	004	0	1	01	01	H3536_004_0	9	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								11.00	22.00	33.00					11.00	22.00	33.00					11.00	33.00	33.00																11.00				11.00			0.37	0.37	0.37			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3536	004	0	1	01	01	H3536_004_0	9	Preferred Brand	4	000101	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												
H3536	004	0	1	01	01	H3536_004_0	9	Non-Preferred Drug	4	100100	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												
H3536	004	0	1	01	01	H3536_004_0	9	Specialty Tier	4	010010	1	1	5	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	9	Select Care Drugs	4	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3536	004	0	1	01	01	H3536_004_0	9	Select Care Drugs	4	001000	1	2	6	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		
H3561	001	0	1	01	01	H3561_001_0	5	Preferred Generic	3	001000	1	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3561	001	0	1	01	01	H3561_001_0	5	Generic	3	010000	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	40.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3561	001	0	1	01	01	H3561_001_0	5	Preferred Brand	3	010001	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	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	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3561	001	0	1	01	01	H3561_001_0	5	Non-Preferred Brand	3	110000	1	2	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	100.00	200.00	300.00																									100.00	200.00	300.00				100.00	200.00	290.00				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												
H3561	001	0	1	01	01	H3561_001_0	5	Specialty Tier	3	010010	1	1	5	1	111		01		111	1	30	60	90				1	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, Select Care Drugs												
H3561	001	0	1	01	01	H3561_001_0	5	Select Care Drugs	3	010010	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3561	002	0	1	01	01	H3561_002_0	4	Preferred Generic	3	001000	1	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3561	002	0	1	01	01	H3561_002_0	4	Generic	3	010000	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	40.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3561	002	0	1	01	01	H3561_002_0	4	Preferred Brand	3	010001	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	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	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3561	002	0	1	01	01	H3561_002_0	4	Non-Preferred Brand	3	110000	1	2	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	100.00	200.00	300.00																									100.00	200.00	300.00				100.00	200.00	290.00				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												
H3561	002	0	1	01	01	H3561_002_0	4	Specialty Tier	3	010010	1	1	5	1	111		01		111	1	30	60	90				1	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, Select Care Drugs												
H3561	002	0	1	01	01	H3561_002_0	4	Select Care Drugs	3	010010	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3561	004	0	1	01	01	H3561_004_0	4	Preferred Generic	3	001000	1	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3561	004	0	1	01	01	H3561_004_0	4	Generic	3	010000	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	40.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3561	004	0	1	01	01	H3561_004_0	4	Preferred Brand	3	010001	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	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	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3561	004	0	1	01	01	H3561_004_0	4	Non-Preferred Brand	3	110000	1	2	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	100.00	200.00	300.00																									100.00	200.00	300.00				100.00	200.00	290.00				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												
H3561	004	0	1	01	01	H3561_004_0	4	Specialty Tier	3	010010	1	1	5	1	111		01		111	1	30	60	90				1	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, Select Care Drugs												
H3561	004	0	1	01	01	H3561_004_0	4	Select Care Drugs	3	010010	1	2	6	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3597	001	0	1	01	01	H3597_001_0	4	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3597	001	0	1	01	01	H3597_001_0	4	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3597	001	0	1	01	01	H3597_001_0	4	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3597	001	0	1	01	01	H3597_001_0	4	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3597	001	0	1	01	01	H3597_001_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3597	001	0	1	01	01	H3597_001_0	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3597	001	0	1	01	01	H3597_001_0	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	27						1.00	27												27						27						27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3597	005	0	1	01	01	H3597_005_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3597	005	0	1	01	01	H3597_005_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3597	005	0	1	01	01	H3597_005_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3597	005	0	1	01	01	H3597_005_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3597	005	0	1	01	01	H3597_005_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	005	0	1	01	01	H3597_005_0	3	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	005	0	1	01	01	H3597_005_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3597	007	0	1	01	01	H3597_007_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3597	007	0	1	01	01	H3597_007_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3597	007	0	1	01	01	H3597_007_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3597	007	0	1	01	01	H3597_007_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3597	007	0	1	01	01	H3597_007_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3597	007	0	1	01	01	H3597_007_0	3	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3597	007	0	1	01	01	H3597_007_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3597	009	0	1	01	01	H3597_009_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3597	009	0	1	01	01	H3597_009_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3597	009	0	1	01	01	H3597_009_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3597	009	0	1	01	01	H3597_009_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3597	009	0	1	01	01	H3597_009_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3597	009	0	1	01	01	H3597_009_0	3	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3597	009	0	1	01	01	H3597_009_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	004	0	1	01	01	H3653_004_0	8	Preferred Generic	4	001001	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		0.06			0.06			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	004	0	1	01	01	H3653_004_0	8	Generic	4	010001	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	15.00		45.00																			15.00		30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	004	0	1	01	01	H3653_004_0	8	Preferred Brand	4	000101	1	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	45.00		135.00																			45.00		90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	004	0	1	01	01	H3653_004_0	8	Non-Preferred Drug	4	100100	1	2	4	1	110		01	110		1	30		90				2	2	30		90				30		31	100.00		300.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	004	0	1	01	01	H3653_004_0	8	Specialty Tier	4	010010	1	1	5	1	010		01			1	30														30		31				483.80	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	015	0	1	01	01	H3653_015_0	9	Preferred Generic	4	001001	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	4.00		12.00																			4.00		8.00																4.00				4.00		0.13			0.13			0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	015	0	1	01	01	H3653_015_0	9	Generic	4	010001	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	20.00		60.00																			20.00		40.00																20.00				20.00		0.66			0.66			0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	015	0	1	01	01	H3653_015_0	9	Preferred Brand	4	000101	1	2	3	1	110		01	110		1	30		90				1	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	9	Non-Preferred Drug	4	100100	1	2	4	1	110		01	110		1	30		90				1	2	30		90				30		31	100.00		300.00																			100.00		200.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3653	015	0	1	01	01	H3653_015_0	9	Specialty Tier	4	010010	1	1	5	1	010		01			1	30														30		31				1027.52	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3655	032	0	1	01	01	H3655_032_0	8	Preferred Generic	4	001000	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												
H3655	032	0	1	01	01	H3655_032_0	8	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	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												
H3655	032	0	1	01	01	H3655_032_0	8	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	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												
H3655	032	0	1	01	01	H3655_032_0	8	Non-Preferred Drug	4	100100	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												
H3655	032	0	1	01	01	H3655_032_0	8	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		34												31							31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	032	0	1	01	01	H3655_032_0	8	Select Care Drugs	4	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	032	0	1	01	01	H3655_032_0	8	Select Care Drugs	4	001000	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3655	033	0	1	01	01	H3655_033_0	6	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	033	0	1	01	01	H3655_033_0	6	Generic	4	010000	1	2	2	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												
H3655	033	0	1	01	01	H3655_033_0	6	Preferred Brand	4	000101	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												
H3655	033	0	1	01	01	H3655_033_0	6	Non-Preferred Drug	4	100100	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												
H3655	033	0	1	01	01	H3655_033_0	6	Specialty Tier	4	010010	1	1	5	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	6	Select Care Drugs	4	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	033	0	1	01	01	H3655_033_0	6	Select Care Drugs	4	001000	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3655	034	0	1	01	01	H3655_034_0	5	Preferred Generic	4	001000	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												
H3655	034	0	1	01	01	H3655_034_0	5	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	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												
H3655	034	0	1	01	01	H3655_034_0	5	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	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												
H3655	034	0	1	01	01	H3655_034_0	5	Non-Preferred Drug	4	100100	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												
H3655	034	0	1	01	01	H3655_034_0	5	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		34												31							31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3655	034	0	1	01	01	H3655_034_0	5	Select Care Drugs	4	001000	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			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	Select Care Drugs	4	001000	1	2	6	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		
H3660	028	0	1	02	01	H3660_028_0	10	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	028	0	1	02	01	H3660_028_0	10	Preferred Generic	4	001000	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3660	028	0	1	02	01	H3660_028_0	10	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	10.00		30.00																					25.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	028	0	1	02	01	H3660_028_0	10	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	45.00		135.00																					112.50																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	028	0	1	02	01	H3660_028_0	10	Non-Preferred Brand	4	100000	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	95.00		285.00																					285.00																95.00				95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	028	0	1	02	01	H3660_028_0	10	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	028	0	1	02	01	H3660_028_0	10	Vaccines	4	010010	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	028	0	1	02	01	H3660_028_0	10	Vaccines	4	010010	1	2	6	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3660	029	0	1	02	01	H3660_029_0	9	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	029	0	1	02	01	H3660_029_0	9	Preferred Generic	4	001000	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3660	029	0	1	02	01	H3660_029_0	9	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	15.00		45.00																					37.50																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	029	0	1	02	01	H3660_029_0	9	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		141.00																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	029	0	1	02	01	H3660_029_0	9	Non-Preferred Brand	4	100000	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	029	0	1	02	01	H3660_029_0	9	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	029	0	1	02	01	H3660_029_0	9	Vaccines	4	010010	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	029	0	1	02	01	H3660_029_0	9	Vaccines	4	010010	1	2	6	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3660	044	0	1	01	01	H3660_044_0	13	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	044	0	1	01	01	H3660_044_0	13	Preferred Generic	4	001000	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3660	044	0	1	01	01	H3660_044_0	13	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	15.00		45.00																					37.50																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	044	0	1	01	01	H3660_044_0	13	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		141.00																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	044	0	1	01	01	H3660_044_0	13	Non-Preferred Brand	4	100000	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	044	0	1	01	01	H3660_044_0	13	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	044	0	1	01	01	H3660_044_0	13	Vaccines	4	010010	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	044	0	1	01	01	H3660_044_0	13	Vaccines	4	010010	1	2	6	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3660	047	0	1	01	01	H3660_047_0	13	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	047	0	1	01	01	H3660_047_0	13	Preferred Generic	4	001000	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3660	047	0	1	01	01	H3660_047_0	13	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	15.00		45.00																					37.50																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	047	0	1	01	01	H3660_047_0	13	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		141.00																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	047	0	1	01	01	H3660_047_0	13	Non-Preferred Brand	4	100000	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	047	0	1	01	01	H3660_047_0	13	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	047	0	1	01	01	H3660_047_0	13	Vaccines	4	010010	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	047	0	1	01	01	H3660_047_0	13	Vaccines	4	010010	1	2	6	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3660	048	0	1	02	01	H3660_048_0	10	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	048	0	1	02	01	H3660_048_0	10	Preferred Generic	4	001000	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3660	048	0	1	02	01	H3660_048_0	10	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	15.00		45.00																					37.50																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	048	0	1	02	01	H3660_048_0	10	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		141.00																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	048	0	1	02	01	H3660_048_0	10	Non-Preferred Brand	4	100000	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	048	0	1	02	01	H3660_048_0	10	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	048	0	1	02	01	H3660_048_0	10	Vaccines	4	010010	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	048	0	1	02	01	H3660_048_0	10	Vaccines	4	010010	1	2	6	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3660	049	0	1	01	01	H3660_049_0	13	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	049	0	1	01	01	H3660_049_0	13	Preferred Generic	4	001000	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3660	049	0	1	01	01	H3660_049_0	13	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	15.00		45.00																					37.50																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	049	0	1	01	01	H3660_049_0	13	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		141.00																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	049	0	1	01	01	H3660_049_0	13	Non-Preferred Brand	4	100000	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	049	0	1	01	01	H3660_049_0	13	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31					30																				30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	049	0	1	01	01	H3660_049_0	13	Vaccines	4	010010	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	049	0	1	01	01	H3660_049_0	13	Vaccines	4	010010	1	2	6	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3660	050	0	1	01	01	H3660_050_0	13	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	050	0	1	01	01	H3660_050_0	13	Preferred Generic	4	001000	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3660	050	0	1	01	01	H3660_050_0	13	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	15.00		45.00																					37.50																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	050	0	1	01	01	H3660_050_0	13	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		141.00																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	050	0	1	01	01	H3660_050_0	13	Non-Preferred Brand	4	100000	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	050	0	1	01	01	H3660_050_0	13	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31					30																				30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	050	0	1	01	01	H3660_050_0	13	Vaccines	4	010010	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H3660	050	0	1	01	01	H3660_050_0	13	Vaccines	4	010010	1	2	6	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H3664	017	0	1	02	01	H3664_017_0	4	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3664	017	0	1	02	01	H3664_017_0	4	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	8.00	16.00	24.00																			8.00	16.00	24.00																8.00				8.00		0.27			0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3664	017	0	1	02	01	H3664_017_0	4	Preferred Brand	4	000001	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3664	017	0	1	02	01	H3664_017_0	4	Non-Preferred Brand	4	100000	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3664	017	0	1	02	01	H3664_017_0	4	Specialty Tier	4	000010	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				2131.51	31	31	31																		31	31	31															31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3664	020	0	1	02	01	H3664_020_0	4	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	6.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3664	020	0	1	02	01	H3664_020_0	4	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	8.00	16.00	24.00																			8.00	16.00	24.00																8.00				8.00		0.27			0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3664	020	0	1	02	01	H3664_020_0	4	Preferred Brand	4	000001	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3664	020	0	1	02	01	H3664_020_0	4	Non-Preferred Brand	4	100000	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3664	020	0	1	02	01	H3664_020_0	4	Specialty Tier	4	000010	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				1466.24	30	30	30																		30	30	30															30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3664	021	0	1	02	01	H3664_021_0	4	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	9.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3664	021	0	1	02	01	H3664_021_0	4	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	45.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3664	021	0	1	02	01	H3664_021_0	4	Preferred Brand	4	000001	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3664	021	0	1	02	01	H3664_021_0	4	Non-Preferred Brand	4	100000	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3664	021	0	1	02	01	H3664_021_0	4	Specialty Tier	4	000010	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				2145.54	29	29	29																		29	29	29															29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3668	005	0	1	01	01	H3668_005_0	13	Preferred Generic	4	001001	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	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	005	0	1	01	01	H3668_005_0	13	Preferred Generic	4	001001	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	005	0	1	01	01	H3668_005_0	13	Generic	4	010001	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	005	0	1	01	01	H3668_005_0	13	Preferred Brand	4	000101	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	005	0	1	01	01	H3668_005_0	13	Non-Preferred Drug	4	100100	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	005	0	1	01	01	H3668_005_0	13	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31				670.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	011	0	1	01	01	H3668_011_0	12	Preferred Generic	4	001001	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	011	0	1	01	01	H3668_011_0	12	Preferred Generic	4	001001	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3668	011	0	1	01	01	H3668_011_0	12	Generic	4	010001	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	18.00	36.00	54.00																			18.00	36.00	36.00																18.00				18.00		0.60			0.60			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	011	0	1	01	01	H3668_011_0	12	Preferred Brand	4	000101	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	011	0	1	01	01	H3668_011_0	12	Non-Preferred Drug	4	100100	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	011	0	1	01	01	H3668_011_0	12	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31				670.00	30																				30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	014	0	1	01	01	H3668_014_0	16	Preferred Generic	4	001001	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	014	0	1	01	01	H3668_014_0	16	Preferred Generic	4	001001	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3668	014	0	1	01	01	H3668_014_0	16	Generic	4	010001	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	014	0	1	01	01	H3668_014_0	16	Preferred Brand	4	000101	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	014	0	1	01	01	H3668_014_0	16	Non-Preferred Drug	4	100100	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	75.00	150.00	225.00																			75.00	150.00	150.00																75.00				75.00		2.50			2.50			2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	014	0	1	01	01	H3668_014_0	16	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31				670.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	015	0	1	01	01	H3668_015_0	16	Preferred Generic	4	001001	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	015	0	1	01	01	H3668_015_0	16	Preferred Generic	4	001001	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3668	015	0	1	01	01	H3668_015_0	16	Generic	4	010001	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	18.00	36.00	54.00																			18.00	36.00	36.00																18.00				18.00		0.60			0.60			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	015	0	1	01	01	H3668_015_0	16	Preferred Brand	4	000101	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	015	0	1	01	01	H3668_015_0	16	Non-Preferred Drug	4	100100	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	015	0	1	01	01	H3668_015_0	16	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31				670.00	29																				29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	016	0	1	01	01	H3668_016_0	16	Preferred Generic	4	001001	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	016	0	1	01	01	H3668_016_0	16	Preferred Generic	4	001001	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3668	016	0	1	01	01	H3668_016_0	16	Generic	4	010001	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	016	0	1	01	01	H3668_016_0	16	Preferred Brand	4	000101	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	016	0	1	01	01	H3668_016_0	16	Non-Preferred Drug	4	100100	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	75.00	150.00	225.00																			75.00	150.00	150.00																75.00				75.00		2.50			2.50			2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	016	0	1	01	01	H3668_016_0	16	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31				670.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	017	0	1	01	01	H3668_017_0	16	Preferred Generic	4	001001	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	017	0	1	01	01	H3668_017_0	16	Preferred Generic	4	001001	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3668	017	0	1	01	01	H3668_017_0	16	Generic	4	010001	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	18.00	36.00	54.00																			18.00	36.00	36.00																18.00				18.00		0.60			0.60			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	017	0	1	01	01	H3668_017_0	16	Preferred Brand	4	000101	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	90.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	017	0	1	01	01	H3668_017_0	16	Non-Preferred Drug	4	100100	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3668	017	0	1	01	01	H3668_017_0	16	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31				670.00	30																				30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3672	013	0	1	01	01	H3672_013_0	7	Preferred Generic	4	001000	1	2	1	1		110	01	100		1				30		90	1	1			90				30		31								13.00		39.00					3.00		9.00							0.00																13.00				13.00			0.43	0.10				0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3672	013	0	1	01	01	H3672_013_0	7	Generic	4	010000	1	2	2	1		110	01	100		1				30		90	1	1			90				30		31								20.00		60.00					10.00		30.00							20.00																20.00				20.00			0.67	0.33				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3672	013	0	1	01	01	H3672_013_0	7	Preferred Brand	4	000001	1	2	3	1		110	01	100		1				30		90	1	1			90				30		31								45.00		135.00					35.00		105.00							70.00																45.00				45.00			1.50	1.17				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3672	013	0	1	01	01	H3672_013_0	7	Non-Preferred Drug	4	100000	1	2	4	1		110	01	100		1				30		90	1	1			90				30		31								95.00		285.00					85.00		255.00							170.00																95.00				95.00			3.17	2.83				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3672	013	0	1	01	01	H3672_013_0	7	Specialty Tier	4	000010	1	1	5	1		010	01	010		1				30					30						30		31											1000.00	31						1000.00	31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3672	018	0	1	01	01	H3672_018_0	7	Preferred Generic	4	001000	1	2	1	1		110	01	100		1				30		90	1	1			90				30		31								15.00		45.00					5.00		15.00							0.00																15.00				15.00			0.50	0.17				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3672	018	0	1	01	01	H3672_018_0	7	Generic	4	010000	1	2	2	1		110	01	100		1				30		90	1	1			90				30		31								20.00		60.00					10.00		30.00							20.00																20.00				20.00			0.67	0.33				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3672	018	0	1	01	01	H3672_018_0	7	Preferred Brand	4	000001	1	2	3	1		110	01	100		1				30		90	1	1			90				30		31								45.00		135.00					35.00		105.00							70.00																45.00				45.00			1.50	1.17				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3672	018	0	1	01	01	H3672_018_0	7	Non-Preferred Drug	4	100000	1	2	4	1		110	01	100		1				30		90	1	1			90				30		31								95.00		285.00					85.00		255.00							170.00																95.00				95.00			3.17	2.83				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3672	018	0	1	01	01	H3672_018_0	7	Specialty Tier	4	000010	1	1	5	1		010	01	010		1				30					30						30		31											1000.00	29						1000.00	29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3672	020	0	1	01	01	H3672_020_0	9	Preferred Generic	4	001000	1	2	1	1		110	01	100		1				30		90	1	1			90				30		31								13.00		39.00					3.00		9.00							0.00																13.00				13.00			0.43	0.10				0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3672	020	0	1	01	01	H3672_020_0	9	Generic	4	010000	1	2	2	1		110	01	100		1				30		90	1	1			90				30		31								20.00		60.00					10.00		30.00							20.00																20.00				20.00			0.67	0.33				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3672	020	0	1	01	01	H3672_020_0	9	Preferred Brand	4	000001	1	2	3	1		110	01	100		1				30		90	1	1			90				30		31								45.00		135.00					35.00		105.00							70.00																45.00				45.00			1.50	1.17				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3672	020	0	1	01	01	H3672_020_0	9	Non-Preferred Drug	4	100000	1	2	4	1		110	01	100		1				30		90	1	1			90				30		31								95.00		285.00					85.00		255.00							170.00																95.00				95.00			3.17	2.83				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3672	020	0	1	01	01	H3672_020_0	9	Specialty Tier	4	000010	1	1	5	1		010	01	010		1				30					30						30		31											1000.00	31						1000.00	31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3672	023	0	1	01	01	H3672_023_0	10	Preferred Generic	4	001000	1	2	1	1		110	01	100		1				30		90	1	1			90				30		31								13.00		39.00					3.00		9.00							0.00																13.00				13.00			0.43	0.10				0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3672	023	0	1	01	01	H3672_023_0	10	Generic	4	010000	1	2	2	1		110	01	100		1				30		90	1	1			90				30		31								20.00		60.00					10.00		30.00							20.00																20.00				20.00			0.67	0.33				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3672	023	0	1	01	01	H3672_023_0	10	Preferred Brand	4	000001	1	2	3	1		110	01	100		1				30		90	1	1			90				30		31								45.00		135.00					35.00		105.00							70.00																45.00				45.00			1.50	1.17				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3672	023	0	1	01	01	H3672_023_0	10	Non-Preferred Drug	4	100000	1	2	4	1		110	01	100		1				30		90	1	1			90				30		31								95.00		285.00					85.00		255.00							170.00																95.00				95.00			3.17	2.83				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3672	023	0	1	01	01	H3672_023_0	10	Specialty Tier	4	000010	1	1	5	1		010	01	010		1				30					30						30		31											1000.00	31						1000.00	31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3706	001	0	1	01	01	H3706_001_0	11	Preferred Generic	4	001001	1	2	1	1		110	01		110	1				30		90	1	1				30		90	30		34								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3706	001	0	1	01	01	H3706_001_0	11	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	1	1				30		90	30		34								20.00		60.00					15.00		45.00											20.00		60.00				15.00		15.00				20.00				20.00			0.67	0.50		0.67	0.50	0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3706	001	0	1	01	01	H3706_001_0	11	Preferred Brand	4	000101	1	2	3	1		110	01		110	1				30		90	1	1				30		90	30		34								47.00		141.00					42.00		126.00											47.00		94.00				42.00		84.00				47.00				47.00			1.57	1.40		1.57	1.40	1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3706	001	0	1	01	01	H3706_001_0	11	Non-Preferred Drug	4	100100	1	1	4	1		110	01		110	1				30		90	1	1				30		90	30		34											96.86	50		50				77.49	40		40										50		50				30		30			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3706	001	0	1	01	01	H3706_001_0	11	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		34											435.00	33						435.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3706	018	0	1	01	01	H3706_018_0	12	Preferred Generic	4	001001	1	2	1	1		110	01		110	1				30		90	1	1				30		90	30		34								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3706	018	0	1	01	01	H3706_018_0	12	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	1	1				30		90	30		34								20.00		60.00					15.00		45.00											20.00		60.00				15.00		15.00				20.00				20.00			0.67	0.50		0.67	0.50	0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3706	018	0	1	01	01	H3706_018_0	12	Preferred Brand	4	000101	1	2	3	1		110	01		110	1				30		90	1	1				30		90	30		34								47.00		141.00					42.00		126.00											47.00		94.00				42.00		84.00				47.00				47.00			1.57	1.40		1.57	1.40	1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3706	018	0	1	01	01	H3706_018_0	12	Non-Preferred Drug	4	100100	1	1	4	1		110	01		110	1				30		90	1	1				30		90	30		34											89.32	50		50				71.46	40		40										50		50				30		30			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3706	018	0	1	01	01	H3706_018_0	12	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		34											435.00	33						435.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3706	019	0	1	01	01	H3706_019_0	12	Preferred Generic	4	001001	1	2	1	1		110	01		110	1				30		90	1	1				30		90	30		34								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3706	019	0	1	01	01	H3706_019_0	12	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	1	1				30		90	30		34								20.00		60.00					15.00		45.00											20.00		60.00				15.00		15.00				20.00				20.00			0.67	0.50		0.67	0.50	0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3706	019	0	1	01	01	H3706_019_0	12	Preferred Brand	4	000101	1	2	3	1		110	01		110	1				30		90	1	1				30		90	30		34								47.00		141.00					42.00		126.00											47.00		94.00				42.00		84.00				47.00				47.00			1.57	1.40		1.57	1.40	1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3706	019	0	1	01	01	H3706_019_0	12	Non-Preferred Drug	4	100100	1	1	4	1		110	01		110	1				30		90	1	1				30		90	30		34											61.59	50		50				49.27	40		40										50		50				30		30			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3706	019	0	1	01	01	H3706_019_0	12	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		34											435.00	33						435.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3749	001	0	1	01	01	H3749_001_0	5	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3749	001	0	1	01	01	H3749_001_0	5	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3749	001	0	1	01	01	H3749_001_0	5	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		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	001	0	1	01	01	H3749_001_0	5	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3749	001	0	1	01	01	H3749_001_0	5	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				783.00	30		30																										30						30			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3749	017	0	1	01	01	H3749_017_0	5	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3749	017	0	1	01	01	H3749_017_0	5	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3749	017	0	1	01	01	H3749_017_0	5	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3749	017	0	1	01	01	H3749_017_0	5	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3749	017	0	1	01	01	H3749_017_0	5	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				757.00	30		30																										30						30			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3749	018	0	1	01	01	H3749_018_0	5	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3749	018	0	1	01	01	H3749_018_0	5	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3749	018	0	1	01	01	H3749_018_0	5	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		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	018	0	1	01	01	H3749_018_0	5	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3749	018	0	1	01	01	H3749_018_0	5	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				716.00	30		30																										30						30			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3755	001	0	1	01	01	H3755_001_0	8	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3755	001	0	1	01	01	H3755_001_0	8	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	12.00	24.00	36.00																			12.00	24.00	24.00																12.00				12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3755	001	0	1	01	01	H3755_001_0	8	Preferred Brand	4	000001	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	40.00	80.00	120.00																			40.00	80.00	80.00																40.00				40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3755	001	0	1	01	01	H3755_001_0	8	Non-Preferred Brand	4	100100	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 Brand, Injectable Drugs, Specialty Tier												
H3755	001	0	1	01	01	H3755_001_0	8	Injectable Drugs	4	100100	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				94.65	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3755	001	0	1	01	01	H3755_001_0	8	Specialty Tier	4	100100	1	1	6	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 Brand, Injectable Drugs, Specialty Tier												
H3755	004	0	1	01	01	H3755_004_0	9	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3755	004	0	1	01	01	H3755_004_0	9	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	12.00	24.00	36.00																			12.00	24.00	24.00																12.00				12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3755	004	0	1	01	01	H3755_004_0	9	Preferred Brand	4	000001	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	40.00	80.00	120.00																			40.00	80.00	80.00																40.00				40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3755	004	0	1	01	01	H3755_004_0	9	Non-Preferred Brand	4	100100	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 Brand, Injectable Drugs, Specialty Tier												
H3755	004	0	1	01	01	H3755_004_0	9	Injectable Drugs	4	100100	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				87.87	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3755	004	0	1	01	01	H3755_004_0	9	Specialty Tier	4	100100	1	1	6	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 Brand, Injectable Drugs, Specialty Tier												
H3755	005	0	1	01	01	H3755_005_0	9	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	15.00																			5.00	10.00	10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3755	005	0	1	01	01	H3755_005_0	9	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	13.00	26.00	39.00																			13.00	26.00	26.00																13.00				13.00		0.43			0.43			0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3755	005	0	1	01	01	H3755_005_0	9	Preferred Brand	4	000001	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	40.00	80.00	120.00																			40.00	80.00	80.00																40.00				40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3755	005	0	1	01	01	H3755_005_0	9	Non-Preferred Brand	4	100100	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	90.00	180.00	270.00																			90.00	180.00	180.00																90.00				90.00		3.00			3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3755	005	0	1	01	01	H3755_005_0	9	Injectable Drugs	4	100100	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				79.76	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H3755	005	0	1	01	01	H3755_005_0	9	Specialty Tier	4	100100	1	1	6	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 Brand, Injectable Drugs, Specialty Tier												
H3765	001	0	1	01	01	H3765_001_0	7	Preferred Generic	4	001000	1	2	1	1	111		01	100		1	31	62	93				1	2			93				31		31	3.00	6.00	7.50																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3765	001	0	1	01	01	H3765_001_0	7	Generic	4	010000	1	2	2	1	111		01	100		1	31	62	93				1	2			93				31		31	15.00	30.00	37.50																					45.00																15.00				15.00		0.48						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3765	001	0	1	01	01	H3765_001_0	7	Preferred Brand	4	000001	1	2	3	1	111		01	100		1	31	62	93				1	2			93				31		31	47.00	94.00	117.50																					141.00																47.00				47.00		1.52						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3765	001	0	1	01	01	H3765_001_0	7	Non-Preferred Brand	4	100100	1	1	4	1	111		01	100		1	31	62	93				1	2			93				31		31				49.08	50	50	50																				50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3765	001	0	1	01	01	H3765_001_0	7	Specialty Tier	4	010010	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												
H3805	001	0	1	01	01	H3805_001_0	5	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	001	0	1	01	01	H3805_001_0	5	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	001	0	1	01	01	H3805_001_0	5	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		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	001	0	1	01	01	H3805_001_0	5	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		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	001	0	1	01	01	H3805_001_0	5	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				751.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	007	0	1	01	01	H3805_007_0	5	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	007	0	1	01	01	H3805_007_0	5	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	007	0	1	01	01	H3805_007_0	5	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		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	007	0	1	01	01	H3805_007_0	5	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		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	007	0	1	01	01	H3805_007_0	5	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				771.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	012	0	1	01	01	H3805_012_0	5	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	012	0	1	01	01	H3805_012_0	5	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	012	0	1	01	01	H3805_012_0	5	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		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	012	0	1	01	01	H3805_012_0	5	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		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	012	0	1	01	01	H3805_012_0	5	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				635.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	013	0	1	01	01	H3805_013_0	5	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	013	0	1	01	01	H3805_013_0	5	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		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	013	0	1	01	01	H3805_013_0	5	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		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	013	0	1	01	01	H3805_013_0	5	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		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	013	0	1	01	01	H3805_013_0	5	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				502.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	014	0	1	01	01	H3805_014_0	5	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	014	0	1	01	01	H3805_014_0	5	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	014	0	1	01	01	H3805_014_0	5	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	014	0	1	01	01	H3805_014_0	5	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	014	0	1	01	01	H3805_014_0	5	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				662.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	015	0	1	01	01	H3805_015_0	5	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	015	0	1	01	01	H3805_015_0	5	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	015	0	1	01	01	H3805_015_0	5	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	015	0	1	01	01	H3805_015_0	5	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	015	0	1	01	01	H3805_015_0	5	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				726.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	016	0	1	01	01	H3805_016_0	5	Preferred Generic	3	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	016	0	1	01	01	H3805_016_0	5	Generic	3	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		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	016	0	1	01	01	H3805_016_0	5	Preferred Brand	3	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	016	0	1	01	01	H3805_016_0	5	Non-Preferred Drug	3	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	016	0	1	01	01	H3805_016_0	5	Specialty Tier	3	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				723.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	017	0	1	01	01	H3805_017_0	5	Preferred Generic	3	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	017	0	1	01	01	H3805_017_0	5	Generic	3	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	017	0	1	01	01	H3805_017_0	5	Preferred Brand	3	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	017	0	1	01	01	H3805_017_0	5	Non-Preferred Drug	3	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	017	0	1	01	01	H3805_017_0	5	Specialty Tier	3	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				722.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	018	0	1	01	01	H3805_018_0	5	Preferred Generic	3	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	018	0	1	01	01	H3805_018_0	5	Generic	3	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		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	018	0	1	01	01	H3805_018_0	5	Preferred Brand	3	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	018	0	1	01	01	H3805_018_0	5	Non-Preferred Drug	3	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	018	0	1	01	01	H3805_018_0	5	Specialty Tier	3	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				721.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	019	0	1	01	01	H3805_019_0	5	Preferred Generic	3	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	019	0	1	01	01	H3805_019_0	5	Generic	3	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	019	0	1	01	01	H3805_019_0	5	Preferred Brand	3	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	019	0	1	01	01	H3805_019_0	5	Non-Preferred Drug	3	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	019	0	1	01	01	H3805_019_0	5	Specialty Tier	3	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				723.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	020	0	1	01	01	H3805_020_0	5	Preferred Generic	3	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	020	0	1	01	01	H3805_020_0	5	Generic	3	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		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	020	0	1	01	01	H3805_020_0	5	Preferred Brand	3	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	020	0	1	01	01	H3805_020_0	5	Non-Preferred Drug	3	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3805	020	0	1	01	01	H3805_020_0	5	Specialty Tier	3	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				723.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3810	003	0	1	01	01	H3810_003_0	6	Preferred Generic	4	001000	1	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	5.00	10.00	0.00																									5.00	10.00	15.00				5.00	10.00	0.00				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3810	003	0	1	01	01	H3810_003_0	6	Preferred Generic	4	001000	1	2	1	3	111		01		111	1	30	60	90				1	2				30	60	90	30		31	10.00	20.00	20.00																									10.00	20.00	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 Brand, Specialty Tier										1		
H3810	003	0	1	01	01	H3810_003_0	6	Generic	4	010000	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	15.00	30.00	30.00																									15.00	30.00	45.00				15.00	30.00	30.00				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3810	003	0	1	01	01	H3810_003_0	6	Preferred Brand	4	000001	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	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 Brand, Specialty Tier												
H3810	003	0	1	01	01	H3810_003_0	6	Non-Preferred Brand	4	100000	1	2	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31	95.00	190.00	190.00																									95.00	190.00	285.00				95.00	190.00	190.00				95.00				95.00		3.17				3.17	3.17	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3810	003	0	1	01	01	H3810_003_0	6	Specialty Tier	4	110001	1	1	5	1	111		01		111	1	30	60	90				1	2				30	60	90	30		31				0.00	25	25	25																								25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3811	002	0	1	01	01	H3811_002_0	9	Preferred Generic	4	001000	1	2	1	1	111		01	100		1	34	60	90				1	2			90				34		31	3.00	6.00	9.00																					9.00																3.00				3.00		0.09						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3811	002	0	1	01	01	H3811_002_0	9	Generic	4	010000	1	2	2	1	111		01	100		1	34	60	90				1	2			90				34		31	9.00	18.00	27.00																					27.00																9.00				9.00		0.26						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3811	002	0	1	01	01	H3811_002_0	9	Preferred Brand	4	000001	1	2	3	1	111		01	100		1	34	60	90				1	2			90				34		31	47.00	94.00	141.00																					141.00																47.00				47.00		1.38						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3811	002	0	1	01	01	H3811_002_0	9	Non-Preferred Drug	4	100100	1	1	4	1	111		01	100		1	34	60	90				1	2			90				34		31				62.00	45	45	45																				45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3811	002	0	1	01	01	H3811_002_0	9	Specialty Tier	4	010010	1	1	5	1	010		01			1	34														34		31				563.00	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3811	009	0	1	01	01	H3811_009_0	8	Preferred Generic	4	001000	1	2	1	1	111		01	100		1	34	60	90				1	2			90				34		31	3.00	6.00	9.00																					9.00																3.00				3.00		0.09						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3811	009	0	1	01	01	H3811_009_0	8	Preferred Generic	4	001000	1	2	1	3	111		01	100		1	34	60	90				1	2			90				34		31	3.00	6.00	9.00																					9.00																3.00				3.00		0.09						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3811	009	0	1	01	01	H3811_009_0	8	Generic	4	010000	1	2	2	1	111		01	100		1	34	60	90				1	2			90				34		31	9.00	18.00	27.00																					27.00																9.00				9.00		0.26						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3811	009	0	1	01	01	H3811_009_0	8	Generic	4	010000	1	2	2	3	111		01	100		1	34	60	90				1	2			90				34		31	9.00	18.00	27.00																					27.00																9.00				9.00		0.26						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3811	009	0	1	01	01	H3811_009_0	8	Preferred Brand	4	000001	1	2	3	1	111		01	100		1	34	60	90				1	2			90				34		31	47.00	94.00	141.00																					141.00																47.00				47.00		1.38						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3811	009	0	1	01	01	H3811_009_0	8	Non-Preferred Drug	4	100100	1	1	4	1	111		01	100		1	34	60	90				1	2			90				34		31				62.00	45	45	45																				45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3811	009	0	1	01	01	H3811_009_0	8	Specialty Tier	4	010010	1	1	5	1	010		01			1	34														34		31				563.00	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3813	006	0	1	04	01	H3813_006_0	5	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	31	62	93				1	2	31	62	93				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 Brand, Specialty Tier												
H3813	006	0	1	04	01	H3813_006_0	5	Generic	4	010000	1	2	2	1	111		01	111		1	31	62	93				1	2	31	62	93				31		31	20.00	40.00	60.00																			20.00	40.00	60.00																20.00				20.00		0.65			0.65			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3813	006	0	1	04	01	H3813_006_0	5	Preferred Brand	4	000001	1	2	3	1	111		01	111		1	31	62	93				1	2	31	62	93				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 Brand, Specialty Tier												
H3813	006	0	1	04	01	H3813_006_0	5	Non-Preferred Brand	4	100000	1	1	4	1	111		01	111		1	31	62	93				1	2	31	62	93				31		31				75.00	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3813	006	0	1	04	01	H3813_006_0	5	Specialty Tier	4	100100	1	1	5	1	010		01	010		1	31								31						31		31				300.00	30																				30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3815	001	0	1	01	01	H3815_001_0	10	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								10.00	13.00	16.00					3.00	6.00	9.00											10.00	13.00	13.00				3.00	6.00	6.00					10.00			3.00			0.33	0.10		0.33	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3815	001	0	1	01	01	H3815_001_0	10	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								10.00	13.00	16.00					3.00	6.00	9.00											10.00	13.00	13.00				3.00	6.00	6.00					10.00			3.00			0.33	0.10		0.33	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H3815	001	0	1	01	01	H3815_001_0	10	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								12.00	17.00	22.00					5.00	10.00	15.00											12.00	17.00	17.00				5.00	10.00	10.00					12.00			5.00			0.40	0.17		0.40	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3815	001	0	1	01	01	H3815_001_0	10	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								37.00	67.00	97.00					30.00	60.00	90.00											37.00	67.00	67.00				30.00	60.00	60.00					37.00			30.00			1.23	1.00		1.23	1.00	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3815	001	0	1	01	01	H3815_001_0	10	Non-Preferred Brand	4	110000	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								82.00	157.00	232.00					75.00	150.00	225.00											82.00	157.00	157.00				75.00	150.00	150.00					82.00			75.00			2.73	2.50		2.73	2.50	2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3815	001	0	1	01	01	H3815_001_0	10	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											999.00	33						999.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3815	001	0	1	01	01	H3815_001_0	10	Select Care Drugs	4	010000	1	2	6	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								3.00	6.00	0.00					3.00	6.00	0.00											3.00	6.00	0.00				3.00	6.00	0.00					3.00			3.00			0.10	0.10		0.10	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3815	001	0	1	01	01	H3815_001_0	10	Select Care Drugs	4	010000	1	2	6	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								3.00	6.00	0.00					3.00	6.00	0.00											3.00	6.00	0.00				3.00	6.00	0.00					3.00			3.00			0.10	0.10		0.10	0.10	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H3815	006	0	1	01	01	H3815_006_0	8	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								12.00	17.00	22.00					5.00	10.00	15.00											12.00	17.00	17.00				5.00	10.00	10.00					12.00			5.00			0.40	0.17		0.40	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3815	006	0	1	01	01	H3815_006_0	8	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								17.00	27.00	37.00					10.00	20.00	30.00											17.00	27.00	27.00				10.00	20.00	20.00					17.00			10.00			0.57	0.33		0.57	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3815	006	0	1	01	01	H3815_006_0	8	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	87.00	127.00					40.00	80.00	120.00											47.00	87.00	87.00				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 Brand, Specialty Tier, Select Care Drugs												
H3815	006	0	1	01	01	H3815_006_0	8	Non-Preferred Brand	4	110000	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	193.00	286.00					93.00	186.00	279.00											100.00	193.00	193.00				93.00	186.00	186.00					100.00			93.00			3.33	3.10		3.33	3.10	3.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3815	006	0	1	01	01	H3815_006_0	8	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											999.00	33						999.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3815	006	0	1	01	01	H3815_006_0	8	Select Care Drugs	4	010000	1	2	6	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								5.00	10.00	0.00					5.00	10.00	0.00											5.00	10.00	0.00				5.00	10.00	0.00					5.00			5.00			0.17	0.17		0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3815	006	0	1	01	01	H3815_006_0	8	Select Care Drugs	4	010000	1	2	6	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								5.00	10.00	0.00					5.00	10.00	0.00											5.00	10.00	0.00				5.00	10.00	0.00					5.00			5.00			0.17	0.17		0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H3815	007	0	1	01	01	H3815_007_0	8	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								7.00	7.00	7.00					0.00	0.00	0.00											7.00	7.00	7.00				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 Brand, Specialty Tier, Select Care Drugs												
H3815	007	0	1	01	01	H3815_007_0	8	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								12.00	17.00	22.00					5.00	10.00	15.00											12.00	17.00	17.00				5.00	10.00	10.00					12.00			5.00			0.40	0.17		0.40	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3815	007	0	1	01	01	H3815_007_0	8	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	87.00	127.00					40.00	80.00	120.00											47.00	87.00	87.00				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 Brand, Specialty Tier, Select Care Drugs												
H3815	007	0	1	01	01	H3815_007_0	8	Non-Preferred Brand	4	110000	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	193.00	286.00					93.00	186.00	279.00											100.00	193.00	193.00				93.00	186.00	186.00					100.00			93.00			3.33	3.10		3.33	3.10	3.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3815	007	0	1	01	01	H3815_007_0	8	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											999.00	33						999.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3815	007	0	1	01	01	H3815_007_0	8	Select Care Drugs	4	010000	1	2	6	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								5.00	10.00	0.00					5.00	10.00	0.00											5.00	10.00	0.00				5.00	10.00	0.00					5.00			5.00			0.17	0.17		0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3815	007	0	1	01	01	H3815_007_0	8	Select Care Drugs	4	010000	1	2	6	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								5.00	10.00	0.00					5.00	10.00	0.00											5.00	10.00	0.00				5.00	10.00	0.00					5.00			5.00			0.17	0.17		0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H3815	008	0	1	01	01	H3815_008_0	8	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								7.00	7.00	7.00					0.00	0.00	0.00											7.00	7.00	7.00				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 Brand, Specialty Tier, Select Care Drugs												
H3815	008	0	1	01	01	H3815_008_0	8	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								7.00	7.00	7.00					0.00	0.00	0.00											7.00	7.00	7.00				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 Brand, Specialty Tier, Select Care Drugs										1		
H3815	008	0	1	01	01	H3815_008_0	8	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								12.00	17.00	22.00					5.00	10.00	15.00											12.00	17.00	17.00				5.00	10.00	10.00					12.00			5.00			0.40	0.17		0.40	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3815	008	0	1	01	01	H3815_008_0	8	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								37.00	67.00	97.00					30.00	60.00	90.00											37.00	67.00	67.00				30.00	60.00	60.00					37.00			30.00			1.23	1.00		1.23	1.00	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3815	008	0	1	01	01	H3815_008_0	8	Non-Preferred Brand	4	110000	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								82.00	157.00	232.00					75.00	150.00	225.00											82.00	157.00	157.00				75.00	150.00	150.00					82.00			75.00			2.73	2.50		2.73	2.50	2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3815	008	0	1	01	01	H3815_008_0	8	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											999.00	33						999.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3815	008	0	1	01	01	H3815_008_0	8	Select Care Drugs	4	010000	1	2	6	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								5.00	10.00	0.00					5.00	10.00	0.00											5.00	10.00	0.00				5.00	10.00	0.00					5.00			5.00			0.17	0.17		0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3815	008	0	1	01	01	H3815_008_0	8	Select Care Drugs	4	010000	1	2	6	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								5.00	10.00	0.00					5.00	10.00	0.00											5.00	10.00	0.00				5.00	10.00	0.00					5.00			5.00			0.17	0.17		0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H3815	010	0	1	01	01	H3815_010_0	9	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								7.00	7.00	7.00					0.00	0.00	0.00											7.00	7.00	7.00				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 Brand, Specialty Tier, Select Care Drugs												
H3815	010	0	1	01	01	H3815_010_0	9	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								7.00	7.00	7.00					0.00	0.00	0.00											7.00	7.00	7.00				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 Brand, Specialty Tier, Select Care Drugs										1		
H3815	010	0	1	01	01	H3815_010_0	9	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								12.00	17.00	22.00					5.00	10.00	15.00											12.00	17.00	17.00				5.00	10.00	10.00					12.00			5.00			0.40	0.17		0.40	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3815	010	0	1	01	01	H3815_010_0	9	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								37.00	67.00	97.00					30.00	60.00	90.00											37.00	67.00	67.00				30.00	60.00	60.00					37.00			30.00			1.23	1.00		1.23	1.00	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3815	010	0	1	01	01	H3815_010_0	9	Non-Preferred Brand	4	110000	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								82.00	157.00	232.00					75.00	150.00	225.00											82.00	157.00	157.00				75.00	150.00	150.00					82.00			75.00			2.73	2.50		2.73	2.50	2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3815	010	0	1	01	01	H3815_010_0	9	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											999.00	33						999.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3815	010	0	1	01	01	H3815_010_0	9	Select Care Drugs	4	010000	1	2	6	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								5.00	10.00	0.00					5.00	10.00	0.00											5.00	10.00	0.00				5.00	10.00	0.00					5.00			5.00			0.17	0.17		0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3815	010	0	1	01	01	H3815_010_0	9	Select Care Drugs	4	010000	1	2	6	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								5.00	10.00	0.00					5.00	10.00	0.00											5.00	10.00	0.00				5.00	10.00	0.00					5.00			5.00			0.17	0.17		0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H3815	011	0	1	01	01	H3815_011_0	8	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								12.00	17.00	22.00					5.00	10.00	15.00											12.00	17.00	17.00				5.00	10.00	10.00					12.00			5.00			0.40	0.17		0.40	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3815	011	0	1	01	01	H3815_011_0	8	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								17.00	27.00	37.00					10.00	20.00	30.00											17.00	27.00	27.00				10.00	20.00	20.00					17.00			10.00			0.57	0.33		0.57	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3815	011	0	1	01	01	H3815_011_0	8	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								47.00	87.00	127.00					40.00	80.00	120.00											47.00	87.00	87.00				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 Brand, Specialty Tier, Select Care Drugs												
H3815	011	0	1	01	01	H3815_011_0	8	Non-Preferred Brand	4	110000	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								100.00	193.00	286.00					93.00	186.00	279.00											100.00	193.00	193.00				93.00	186.00	186.00					100.00			93.00			3.33	3.10		3.33	3.10	3.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3815	011	0	1	01	01	H3815_011_0	8	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											999.00	33						999.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3815	011	0	1	01	01	H3815_011_0	8	Select Care Drugs	4	010000	1	2	6	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								5.00	10.00	0.00					5.00	10.00	0.00											5.00	10.00	0.00				5.00	10.00	0.00					5.00			5.00			0.17	0.17		0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3815	011	0	1	01	01	H3815_011_0	8	Select Care Drugs	4	010000	1	2	6	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								5.00	10.00	0.00					5.00	10.00	0.00											5.00	10.00	0.00				5.00	10.00	0.00					5.00			5.00			0.17	0.17		0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H3815	012	0	1	01	01	H3815_012_0	9	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								7.00	7.00	7.00					0.00	0.00	0.00											7.00	7.00	7.00				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 Brand, Specialty Tier, Select Care Drugs												
H3815	012	0	1	01	01	H3815_012_0	9	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								7.00	7.00	7.00					0.00	0.00	0.00											7.00	7.00	7.00				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 Brand, Specialty Tier, Select Care Drugs										1		
H3815	012	0	1	01	01	H3815_012_0	9	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								12.00	17.00	22.00					5.00	10.00	15.00											12.00	17.00	17.00				5.00	10.00	10.00					12.00			5.00			0.40	0.17		0.40	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3815	012	0	1	01	01	H3815_012_0	9	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								37.00	67.00	97.00					30.00	60.00	90.00											37.00	67.00	67.00				30.00	60.00	60.00					37.00			30.00			1.23	1.00		1.23	1.00	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3815	012	0	1	01	01	H3815_012_0	9	Non-Preferred Brand	4	110000	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								82.00	157.00	232.00					75.00	150.00	225.00											82.00	157.00	157.00				75.00	150.00	150.00					82.00			75.00			2.73	2.50		2.73	2.50	2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3815	012	0	1	01	01	H3815_012_0	9	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											999.00	33						999.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3815	012	0	1	01	01	H3815_012_0	9	Select Care Drugs	4	010000	1	2	6	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								5.00	10.00	0.00					5.00	10.00	0.00											5.00	10.00	0.00				5.00	10.00	0.00					5.00			5.00			0.17	0.17		0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3815	012	0	1	01	01	H3815_012_0	9	Select Care Drugs	4	010000	1	2	6	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								5.00	10.00	0.00					5.00	10.00	0.00											5.00	10.00	0.00				5.00	10.00	0.00					5.00			5.00			0.17	0.17		0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H3815	013	0	1	01	01	H3815_013_0	6	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								12.00	17.00	22.00					5.00	10.00	15.00											12.00	17.00	17.00				5.00	10.00	10.00					12.00			5.00			0.40	0.17		0.40	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3815	013	0	1	01	01	H3815_013_0	6	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								12.00	17.00	22.00					5.00	10.00	15.00											12.00	17.00	17.00				5.00	10.00	10.00					12.00			5.00			0.40	0.17		0.40	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H3815	013	0	1	01	01	H3815_013_0	6	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								17.00	27.00	37.00					10.00	20.00	30.00											17.00	27.00	27.00				10.00	20.00	20.00					17.00			10.00			0.57	0.33		0.57	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3815	013	0	1	01	01	H3815_013_0	6	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								37.00	67.00	97.00					30.00	60.00	90.00											37.00	67.00	67.00				30.00	60.00	60.00					37.00			30.00			1.23	1.00		1.23	1.00	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3815	013	0	1	01	01	H3815_013_0	6	Non-Preferred Brand	4	110000	1	2	4	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								82.00	157.00	232.00					75.00	150.00	225.00											82.00	157.00	157.00				75.00	150.00	150.00					82.00			75.00			2.73	2.50		2.73	2.50	2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3815	013	0	1	01	01	H3815_013_0	6	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											999.00	33						999.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3815	013	0	1	01	01	H3815_013_0	6	Select Care Drugs	4	010000	1	2	6	1		111	10		111	1				30	60	100	1	2				30	60	100		10	31								5.00	10.00	0.00					5.00	10.00	0.00											5.00	10.00	0.00				5.00	10.00	0.00					5.00			5.00			0.17	0.17		0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H3815	013	0	1	01	01	H3815_013_0	6	Select Care Drugs	4	010000	1	2	6	3		111	10		111	1				30	60	100	1	2				30	60	100		10	31								5.00	10.00	0.00					5.00	10.00	0.00											5.00	10.00	0.00				5.00	10.00	0.00					5.00			5.00			0.17	0.17		0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H3817	008	1	1	04	01	H3817_008_1	8	Preferred Generic	3	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	10.00																			5.00	10.00	10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3817	008	1	1	04	01	H3817_008_1	8	Generic	3	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	30.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3817	008	1	1	04	01	H3817_008_1	8	Preferred Brand	3	000001	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, Select Care Drugs												
H3817	008	1	1	04	01	H3817_008_1	8	Non-Preferred Drug	3	100100	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				85.50	45	45	45																		45	45	45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3817	008	1	1	04	01	H3817_008_1	8	Specialty Tier	3	010010	1	1	5	1	010		01	010		1	30								30						30		31				1044.40	28																				28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3817	008	1	1	04	01	H3817_008_1	8	Select Care Drugs	3	010000	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3817	008	2	1	04	01	H3817_008_2	8	Preferred Generic	3	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	10.00																			5.00	10.00	10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3817	008	2	1	04	01	H3817_008_2	8	Generic	3	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	30.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3817	008	2	1	04	01	H3817_008_2	8	Preferred Brand	3	000001	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, Select Care Drugs												
H3817	008	2	1	04	01	H3817_008_2	8	Non-Preferred Drug	3	100100	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				85.50	45	45	45																		45	45	45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3817	008	2	1	04	01	H3817_008_2	8	Specialty Tier	3	010010	1	1	5	1	010		01	010		1	30								30						30		31				1044.40	28																				28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3817	008	2	1	04	01	H3817_008_2	8	Select Care Drugs	3	010000	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3817	009	1	1	04	01	H3817_009_1	8	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	6.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3817	009	1	1	04	01	H3817_009_1	8	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	9.00	18.00	18.00																			9.00	18.00	18.00																9.00				9.00		0.30			0.30			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3817	009	1	1	04	01	H3817_009_1	8	Preferred Brand	4	000001	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, Select Care Drugs												
H3817	009	1	1	04	01	H3817_009_1	8	Non-Preferred Drug	4	100100	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				76.00	40	40	40																		40	40	40															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3817	009	1	1	04	01	H3817_009_1	8	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31				1230.90	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3817	009	1	1	04	01	H3817_009_1	8	Select Care Drugs	4	010000	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3817	009	2	1	04	01	H3817_009_2	8	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	6.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3817	009	2	1	04	01	H3817_009_2	8	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	9.00	18.00	18.00																			9.00	18.00	18.00																9.00				9.00		0.30			0.30			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3817	009	2	1	04	01	H3817_009_2	8	Preferred Brand	4	000001	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, Select Care Drugs												
H3817	009	2	1	04	01	H3817_009_2	8	Non-Preferred Drug	4	100100	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				76.00	40	40	40																		40	40	40															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3817	009	2	1	04	01	H3817_009_2	8	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31				1230.90	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3817	009	2	1	04	01	H3817_009_2	8	Select Care Drugs	4	010000	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3818	002	0	1	01	01	H3818_002_0	17	Preferred Generic	4	001000	1	1	1	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31				0.00	0	0	0																		0	0	0																0		0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3818	002	0	1	01	01	H3818_002_0	17	Preferred Generic	4	001000	1	1	1	3	111		10	111		1	30	60	90				1	2	30	60	90					10	31				1.00	0	0	0																		0	0	0																0		0								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3818	002	0	1	01	01	H3818_002_0	17	Generic	4	010000	1	1	2	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31				5.36	25	25	25																		25	25	25																25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3818	002	0	1	01	01	H3818_002_0	17	Preferred Brand	4	010001	1	1	3	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31				25.11	25	25	25																		25	25	25																25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3818	002	0	1	01	01	H3818_002_0	17	Non-Preferred Drug	4	110000	1	1	4	1	111		10	111		1	30	60	90				1	2	30	60	90					10	31				35.51	25	25	25																		25	25	25																25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3818	002	0	1	01	01	H3818_002_0	17	Specialty Tier	4	000010	1	1	5	1	010		10	010		1	30								30							10	31				463.51	25																				25																		25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3818	003	0	1	01	01	H3818_003_0	16	Preferred Generic	4	001000	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		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3818	003	0	1	01	01	H3818_003_0	16	Preferred Generic	4	001000	1	2	1	3	111		10		111	1	30	60	90				1	2				30	60	90		10	31	0.00	0.00	0.00																									0.00	0.00	0.00				0.00	0.00	0.00					0.00			0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3818	003	0	1	01	01	H3818_003_0	16	Generic	4	010000	1	2	2	1	111		10		111	1	30	60	90				1	2				30	60	90		10	31	20.00	40.00	60.00																									20.00	40.00	60.00				20.00	20.00	20.00					20.00			20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3818	003	0	1	01	01	H3818_003_0	16	Preferred Brand	4	010001	1	2	3	1	111		10		111	1	30	60	90				1	2				30	60	90		10	31	35.00	70.00	105.00																									35.00	70.00	105.00				35.00	35.00	35.00					35.00			35.00		1.17				1.17	1.17	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3818	003	0	1	01	01	H3818_003_0	16	Non-Preferred Drug	4	110000	1	2	4	1	111		10		111	1	30	60	90				1	2				30	60	90		10	31	90.00	180.00	270.00																									90.00	180.00	270.00				90.00	90.00	90.00					90.00			90.00		3.00				3.00	3.00	2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3818	003	0	1	01	01	H3818_003_0	16	Specialty Tier	4	000010	1	1	5	1	010		10		010	1	30											30				10	31					28																										28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3822	001	0	1	01	01	H3822_001_0	9	Preferred Generic	4	001010	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							27.00																9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	001	0	1	01	01	H3822_001_0	9	Preferred Generic	4	001010	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							27.00																9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3822	001	0	1	01	01	H3822_001_0	9	Generic	4	010000	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								15.00		45.00					6.00		18.00							45.00																15.00				15.00			0.50	0.20				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	001	0	1	01	01	H3822_001_0	9	Generic	4	010000	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								15.00		45.00					6.00		18.00							45.00																15.00				15.00			0.50	0.20				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3822	001	0	1	01	01	H3822_001_0	9	Preferred Brand	4	010001	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					39.00		117.00							141.00																47.00				47.00			1.57	1.30				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	001	0	1	01	01	H3822_001_0	9	Non-Preferred Brand	4	110000	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								99.00		297.00					85.00		255.00							297.00																99.00				99.00			3.30	2.83				3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	001	0	1	01	01	H3822_001_0	9	Specialty Tier	4	010010	1	1	5	1		110	01	100		1				30		90	1	2			90				30		31											721.07	33		33				744.80	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	002	0	1	01	01	H3822_002_0	10	Preferred Generic	4	001010	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							27.00																9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	002	0	1	01	01	H3822_002_0	10	Preferred Generic	4	001010	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							27.00																9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3822	002	0	1	01	01	H3822_002_0	10	Generic	4	010000	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		60.00					9.00		27.00							60.00																20.00				20.00			0.67	0.30				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	002	0	1	01	01	H3822_002_0	10	Generic	4	010000	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								20.00		60.00					9.00		27.00							60.00																20.00				20.00			0.67	0.30				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3822	002	0	1	01	01	H3822_002_0	10	Preferred Brand	4	010001	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					39.00		117.00							141.00																47.00				47.00			1.57	1.30				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	002	0	1	01	01	H3822_002_0	10	Non-Preferred Brand	4	110000	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								100.00		300.00					95.00		285.00							300.00																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	002	0	1	01	01	H3822_002_0	10	Specialty Tier	4	010010	1	1	5	1		110	01	100		1				30		90	1	2			90				30		31											792.56	33		33				795.74	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	003	0	1	01	01	H3822_003_0	9	Preferred Generic	4	001000	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							27.00																9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	003	0	1	01	01	H3822_003_0	9	Preferred Generic	4	001000	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							27.00																9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3822	003	0	1	01	01	H3822_003_0	9	Generic	4	010010	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		60.00					9.00		27.00							60.00																20.00				20.00			0.67	0.30				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	003	0	1	01	01	H3822_003_0	9	Generic	4	010010	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								20.00		60.00					9.00		27.00							60.00																20.00				20.00			0.67	0.30				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3822	003	0	1	01	01	H3822_003_0	9	Preferred Brand	4	010001	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					39.00		117.00							141.00																47.00				47.00			1.57	1.30				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	003	0	1	01	01	H3822_003_0	9	Non-Preferred Brand	4	110000	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								100.00		300.00					95.00		285.00							300.00																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	003	0	1	01	01	H3822_003_0	9	Specialty Tier	4	010010	1	1	5	1		110	01	100		1				30		90	1	2			90				30		31											725.86	33		33				761.92	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	007	0	1	02	01	H3822_007_0	11	Preferred Generic	4	001000	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							27.00																9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	007	0	1	02	01	H3822_007_0	11	Preferred Generic	4	001000	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							27.00																9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3822	007	0	1	02	01	H3822_007_0	11	Generic	4	010010	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								15.00		45.00					6.00		18.00							45.00																15.00				15.00			0.50	0.20				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	007	0	1	02	01	H3822_007_0	11	Generic	4	010010	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								15.00		45.00					6.00		18.00							45.00																15.00				15.00			0.50	0.20				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3822	007	0	1	02	01	H3822_007_0	11	Preferred Brand	4	010001	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					39.00		117.00							141.00																47.00				47.00			1.57	1.30				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	007	0	1	02	01	H3822_007_0	11	Non-Preferred Brand	4	110000	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								99.00		297.00					85.00		255.00							297.00																99.00				99.00			3.30	2.83				3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	007	0	1	02	01	H3822_007_0	11	Specialty Tier	4	010010	1	1	5	1		110	01	100		1				30		90	1	2			90				30		31											955.00	33		33				993.41	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	008	0	1	02	01	H3822_008_0	9	Preferred Generic	4	001000	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							27.00																9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	008	0	1	02	01	H3822_008_0	9	Preferred Generic	4	001000	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							27.00																9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3822	008	0	1	02	01	H3822_008_0	9	Generic	4	010010	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								15.00		45.00					6.00		18.00							45.00																15.00				15.00			0.50	0.20				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	008	0	1	02	01	H3822_008_0	9	Generic	4	010010	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								15.00		45.00					6.00		18.00							45.00																15.00				15.00			0.50	0.20				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3822	008	0	1	02	01	H3822_008_0	9	Preferred Brand	4	010001	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					39.00		117.00							141.00																47.00				47.00			1.57	1.30				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	008	0	1	02	01	H3822_008_0	9	Non-Preferred Brand	4	110000	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								99.00		297.00					85.00		255.00							297.00																99.00				99.00			3.30	2.83				3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	008	0	1	02	01	H3822_008_0	9	Specialty Tier	4	010010	1	1	5	1		110	01	100		1				30		90	1	2			90				30		31											762.25	33		33				759.84	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	009	0	1	01	01	H3822_009_0	9	Preferred Generic	4	001000	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							27.00																9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	009	0	1	01	01	H3822_009_0	9	Preferred Generic	4	001000	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							27.00																9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3822	009	0	1	01	01	H3822_009_0	9	Generic	4	010010	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								15.00		45.00					6.00		18.00							45.00																15.00				15.00			0.50	0.20				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	009	0	1	01	01	H3822_009_0	9	Generic	4	010010	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								15.00		45.00					6.00		18.00							45.00																15.00				15.00			0.50	0.20				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3822	009	0	1	01	01	H3822_009_0	9	Preferred Brand	4	010001	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					39.00		117.00							141.00																47.00				47.00			1.57	1.30				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	009	0	1	01	01	H3822_009_0	9	Non-Preferred Brand	4	110000	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								99.00		297.00					85.00		255.00							297.00																99.00				99.00			3.30	2.83				3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3822	009	0	1	01	01	H3822_009_0	9	Specialty Tier	4	010010	1	1	5	1		110	01	100		1				30		90	1	2			90				30		31											668.49	33		33				671.99	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3832	007	0	1	04	01	H3832_007_0	12	Preferred Generic	3	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	5.00		15.00																					5.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3832	007	0	1	04	01	H3832_007_0	12	Generic	3	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	20.00		60.00																					20.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3832	007	0	1	04	01	H3832_007_0	12	Preferred Brand	3	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		141.00																					94.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3832	007	0	1	04	01	H3832_007_0	12	Non-Preferred Drug	3	100000	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		300.00																					200.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3832	007	0	1	04	01	H3832_007_0	12	Specialty Tier	3	010010	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31					25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3832	008	0	1	04	01	H3832_008_0	10	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	4.00		12.00																					4.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3832	008	0	1	04	01	H3832_008_0	10	Preferred Generic	4	001000	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	4.00		12.00																					4.00																4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3832	008	0	1	04	01	H3832_008_0	10	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	11.00		33.00																					11.00																11.00				11.00		0.37						0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3832	008	0	1	04	01	H3832_008_0	10	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	45.00		135.00																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3832	008	0	1	04	01	H3832_008_0	10	Non-Preferred Drug	4	100000	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	95.00		285.00																					190.00																95.00				95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3832	008	0	1	04	01	H3832_008_0	10	Specialty Tier	4	010010	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31					33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3832	009	0	1	04	01	H3832_009_0	8	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	4.50		13.50																					4.50																4.50				4.50		0.15						0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3832	009	0	1	04	01	H3832_009_0	8	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	12.00		36.00																					12.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3832	009	0	1	04	01	H3832_009_0	8	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		141.00																					94.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3832	009	0	1	04	01	H3832_009_0	8	Non-Preferred Drug	4	100000	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		300.00																					200.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3832	009	0	1	04	01	H3832_009_0	8	Specialty Tier	4	010010	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31					25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3832	010	0	1	04	01	H3832_010_0	8	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	4.00		12.00																					4.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3832	010	0	1	04	01	H3832_010_0	8	Preferred Generic	4	001000	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	4.00		12.00																					4.00																4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3832	010	0	1	04	01	H3832_010_0	8	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	11.00		33.00																					11.00																11.00				11.00		0.37						0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3832	010	0	1	04	01	H3832_010_0	8	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	45.00		135.00																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3832	010	0	1	04	01	H3832_010_0	8	Non-Preferred Drug	4	100000	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	95.00		285.00																					190.00																95.00				95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3832	010	0	1	04	01	H3832_010_0	8	Specialty Tier	4	010010	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31					33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3864	006	0	1	01	01	H3864_006_0	6	Preferred Generic	4	001000	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											7.00	14.00	21.00				2.00	4.00	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, Select Care Drugs												
H3864	006	0	1	01	01	H3864_006_0	6	Generic	4	010000	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	36.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	006	0	1	01	01	H3864_006_0	6	Preferred Brand	4	000001	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	006	0	1	01	01	H3864_006_0	6	Preferred Brand	4	000001	1	2	3	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2		
H3864	006	0	1	01	01	H3864_006_0	6	Non-Preferred Drug	4	100100	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	270.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	006	0	1	01	01	H3864_006_0	6	Non-Preferred Drug	4	100100	1	2	4	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	270.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H3864	006	0	1	01	01	H3864_006_0	6	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	006	0	1	01	01	H3864_006_0	6	Select Care Drugs	4	010000	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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	6	Select Care Drugs	4	010000	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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	9	Preferred Generic	4	001000	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											7.00	14.00	21.00				2.00	4.00	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, Select Care Drugs												
H3864	014	0	1	02	01	H3864_014_0	9	Generic	4	010000	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	36.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	014	0	1	02	01	H3864_014_0	9	Preferred Brand	4	000001	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	014	0	1	02	01	H3864_014_0	9	Preferred Brand	4	000001	1	2	3	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2		
H3864	014	0	1	02	01	H3864_014_0	9	Non-Preferred Drug	4	100100	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	270.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	014	0	1	02	01	H3864_014_0	9	Non-Preferred Drug	4	100100	1	2	4	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	270.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H3864	014	0	1	02	01	H3864_014_0	9	Specialty Tier	4	010010	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	014	0	1	02	01	H3864_014_0	9	Select Care Drugs	4	010000	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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	9	Select Care Drugs	4	010000	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3864	021	0	1	01	01	H3864_021_0	6	Preferred Generic	4	001000	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											7.00	14.00	21.00				2.00	4.00	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, Select Care Drugs												
H3864	021	0	1	01	01	H3864_021_0	6	Generic	4	010000	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	36.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	021	0	1	01	01	H3864_021_0	6	Preferred Brand	4	000001	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	021	0	1	01	01	H3864_021_0	6	Preferred Brand	4	000001	1	2	3	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2		
H3864	021	0	1	01	01	H3864_021_0	6	Non-Preferred Drug	4	100100	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	270.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	021	0	1	01	01	H3864_021_0	6	Non-Preferred Drug	4	100100	1	2	4	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	270.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H3864	021	0	1	01	01	H3864_021_0	6	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	021	0	1	01	01	H3864_021_0	6	Select Care Drugs	4	010000	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	021	0	1	01	01	H3864_021_0	6	Select Care Drugs	4	010000	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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	022	0	1	01	01	H3864_022_0	6	Preferred Generic	4	001000	1	2	1	1		111	01		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, Select Care Drugs												
H3864	022	0	1	01	01	H3864_022_0	6	Generic	4	010000	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	36.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	022	0	1	01	01	H3864_022_0	6	Preferred Brand	4	000001	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	022	0	1	01	01	H3864_022_0	6	Preferred Brand	4	000001	1	2	3	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2		
H3864	022	0	1	01	01	H3864_022_0	6	Non-Preferred Drug	4	100100	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	270.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	022	0	1	01	01	H3864_022_0	6	Non-Preferred Drug	4	100100	1	2	4	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	270.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H3864	022	0	1	01	01	H3864_022_0	6	Specialty Tier	4	010010	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	022	0	1	01	01	H3864_022_0	6	Select Care Drugs	4	010000	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	022	0	1	01	01	H3864_022_0	6	Select Care Drugs	4	010000	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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	023	0	1	01	01	H3864_023_0	6	Preferred Generic	4	001000	1	2	1	1		111	01		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, Select Care Drugs												
H3864	023	0	1	01	01	H3864_023_0	6	Generic	4	010000	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	36.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	023	0	1	01	01	H3864_023_0	6	Preferred Brand	4	000001	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	023	0	1	01	01	H3864_023_0	6	Preferred Brand	4	000001	1	2	3	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2		
H3864	023	0	1	01	01	H3864_023_0	6	Non-Preferred Drug	4	100100	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	270.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	023	0	1	01	01	H3864_023_0	6	Non-Preferred Drug	4	100100	1	2	4	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	270.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H3864	023	0	1	01	01	H3864_023_0	6	Specialty Tier	4	010010	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	023	0	1	01	01	H3864_023_0	6	Select Care Drugs	4	010000	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	023	0	1	01	01	H3864_023_0	6	Select Care Drugs	4	010000	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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	9	Preferred Generic	4	001000	1	2	1	1		111	01		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, Select Care Drugs												
H3864	024	0	1	02	01	H3864_024_0	9	Generic	4	010000	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	36.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	024	0	1	02	01	H3864_024_0	9	Preferred Brand	4	000001	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	024	0	1	02	01	H3864_024_0	9	Preferred Brand	4	000001	1	2	3	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2		
H3864	024	0	1	02	01	H3864_024_0	9	Non-Preferred Drug	4	100100	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	270.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	024	0	1	02	01	H3864_024_0	9	Non-Preferred Drug	4	100100	1	2	4	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	270.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H3864	024	0	1	02	01	H3864_024_0	9	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	024	0	1	02	01	H3864_024_0	9	Select Care Drugs	4	010000	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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	9	Select Care Drugs	4	010000	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3864	026	1	1	01	01	H3864_026_1	6	Preferred Generic	4	001000	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											7.00	14.00	21.00				2.00	4.00	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, Select Care Drugs												
H3864	026	1	1	01	01	H3864_026_1	6	Generic	4	010000	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	36.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	026	1	1	01	01	H3864_026_1	6	Preferred Brand	4	000001	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	026	1	1	01	01	H3864_026_1	6	Preferred Brand	4	000001	1	2	3	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2		
H3864	026	1	1	01	01	H3864_026_1	6	Non-Preferred Drug	4	100100	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	270.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	026	1	1	01	01	H3864_026_1	6	Non-Preferred Drug	4	100100	1	2	4	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	270.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H3864	026	1	1	01	01	H3864_026_1	6	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	026	1	1	01	01	H3864_026_1	6	Select Care Drugs	4	010000	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	026	1	1	01	01	H3864_026_1	6	Select Care Drugs	4	010000	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H3864	026	2	1	01	01	H3864_026_2	7	Preferred Generic	4	001000	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											7.00	14.00	21.00				2.00	4.00	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, Select Care Drugs												
H3864	026	2	1	01	01	H3864_026_2	7	Generic	4	010000	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	36.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	026	2	1	01	01	H3864_026_2	7	Preferred Brand	4	000001	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	026	2	1	01	01	H3864_026_2	7	Preferred Brand	4	000001	1	2	3	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2		
H3864	026	2	1	01	01	H3864_026_2	7	Non-Preferred Drug	4	100100	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	270.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	026	2	1	01	01	H3864_026_2	7	Non-Preferred Drug	4	100100	1	2	4	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	270.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H3864	026	2	1	01	01	H3864_026_2	7	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	026	2	1	01	01	H3864_026_2	7	Select Care Drugs	4	010000	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	026	2	1	01	01	H3864_026_2	7	Select Care Drugs	4	010000	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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	11	Preferred Generic	3	001000	1	2	1	1		111	01		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, Select Care Drugs												
H3864	027	0	1	01	01	H3864_027_0	11	Generic	3	010000	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				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	027	0	1	01	01	H3864_027_0	11	Preferred Brand	3	000001	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	027	0	1	01	01	H3864_027_0	11	Non-Preferred Drug	3	100100	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	270.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	027	0	1	01	01	H3864_027_0	11	Specialty Tier	3	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3864	027	0	1	01	01	H3864_027_0	11	Select Care Drugs	3	010000	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3890	001	0	1	04	01	H3890_001_0	7	Preferred Generic	4	001001	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	7.00	14.00	21.00																			7.00	14.00	17.50																7.00				7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3890	001	0	1	04	01	H3890_001_0	7	Generic	4	010001	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												
H3890	001	0	1	04	01	H3890_001_0	7	Preferred Brand	4	000101	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												
H3890	001	0	1	04	01	H3890_001_0	7	Non-Preferred Drug	4	100100	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												
H3890	001	0	1	04	01	H3890_001_0	7	Specialty Tier	4	010010	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	7	Preferred Generic	4	001001	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	10.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3890	002	0	1	04	01	H3890_002_0	7	Generic	4	010001	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	30.00																12.00				12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3890	002	0	1	04	01	H3890_002_0	7	Preferred Brand	4	000101	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	105.00																42.00				42.00		1.40			1.40			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3890	002	0	1	04	01	H3890_002_0	7	Non-Preferred Drug	4	100100	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	92.00	184.00	276.00																			92.00	184.00	230.00																92.00				92.00		3.07			3.07			2.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3890	002	0	1	04	01	H3890_002_0	7	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3907	006	0	1	01	01	H3907_006_0	6	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	12.00		36.00																					24.00																12.00				12.00		0.40						0.39	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3907	006	0	1	01	01	H3907_006_0	6	Preferred Brand	4	010001	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	47.00		141.00																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3907	006	0	1	01	01	H3907_006_0	6	Non-Preferred Drug	4	110000	1	2	3	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, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3907	006	0	1	01	01	H3907_006_0	6	Specialty Tier	4	010010	1	1	4	1	010		01	010		1	30								30						30		31				521.01	33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3907	006	0	1	01	01	H3907_006_0	6	Select Care Drugs	4	010000	1	2	5	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3907	029	0	1	01	01	H3907_029_0	5	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	12.00		36.00																					24.00																12.00				12.00		0.40						0.39	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3907	029	0	1	01	01	H3907_029_0	5	Preferred Brand	4	010001	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	47.00		141.00																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3907	029	0	1	01	01	H3907_029_0	5	Non-Preferred Drug	4	110000	1	2	3	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, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3907	029	0	1	01	01	H3907_029_0	5	Specialty Tier	4	010010	1	1	4	1	010		01	010		1	30								30						30		31				550.48	33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3907	029	0	1	01	01	H3907_029_0	5	Select Care Drugs	4	010000	1	2	5	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3907	037	0	1	01	01	H3907_037_0	6	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	14.00		42.00																					28.00																14.00				14.00		0.47						0.45	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3907	037	0	1	01	01	H3907_037_0	6	Preferred Brand	4	010001	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	47.00		141.00																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3907	037	0	1	01	01	H3907_037_0	6	Non-Preferred Drug	4	110000	1	2	3	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, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3907	037	0	1	01	01	H3907_037_0	6	Specialty Tier	4	010010	1	1	4	1	010		01	010		1	30								30						30		31				534.79	33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3907	037	0	1	01	01	H3907_037_0	6	Select Care Drugs	4	010000	1	2	5	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3907	039	0	1	01	01	H3907_039_0	8	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	14.00		42.00																					28.00																14.00				14.00		0.47						0.45	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3907	039	0	1	01	01	H3907_039_0	8	Preferred Brand	4	010001	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	47.00		141.00																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3907	039	0	1	01	01	H3907_039_0	8	Non-Preferred Drug	4	110000	1	2	3	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, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3907	039	0	1	01	01	H3907_039_0	8	Specialty Tier	4	010010	1	1	4	1	010		01	010		1	30								30						30		31				685.63	33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3907	039	0	1	01	01	H3907_039_0	8	Select Care Drugs	4	010000	1	2	5	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3907	040	0	1	01	01	H3907_040_0	7	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	12.00		36.00																					24.00																12.00				12.00		0.40						0.39	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3907	040	0	1	01	01	H3907_040_0	7	Preferred Brand	4	010001	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	47.00		141.00																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3907	040	0	1	01	01	H3907_040_0	7	Non-Preferred Drug	4	110000	1	2	3	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, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3907	040	0	1	01	01	H3907_040_0	7	Specialty Tier	4	010010	1	1	4	1	010		01	010		1	30								30						30		31				553.73	33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3907	040	0	1	01	01	H3907_040_0	7	Select Care Drugs	4	010000	1	2	5	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3907	042	0	1	01	01	H3907_042_0	7	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	12.00		36.00																					24.00																12.00				12.00		0.40						0.39	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3907	042	0	1	01	01	H3907_042_0	7	Preferred Brand	4	010001	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	47.00		141.00																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3907	042	0	1	01	01	H3907_042_0	7	Non-Preferred Drug	4	110000	1	2	3	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, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3907	042	0	1	01	01	H3907_042_0	7	Specialty Tier	4	010010	1	1	4	1	010		01	010		1	30								30						30		31				553.73	33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3907	042	0	1	01	01	H3907_042_0	7	Select Care Drugs	4	010000	1	2	5	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3907	043	0	1	01	01	H3907_043_0	7	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	14.00		42.00																					28.00																14.00				14.00		0.47						0.45	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3907	043	0	1	01	01	H3907_043_0	7	Preferred Brand	4	010001	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	47.00		141.00																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3907	043	0	1	01	01	H3907_043_0	7	Non-Preferred Drug	4	110000	1	2	3	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, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3907	043	0	1	01	01	H3907_043_0	7	Specialty Tier	4	010010	1	1	4	1	010		01	010		1	30								30						30		31				536.66	33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3907	043	0	1	01	01	H3907_043_0	7	Select Care Drugs	4	010000	1	2	5	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H3909	001	0	1	04	01	H3909_001_0	4	Preferred Generic	4	001000	1	2	1	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					3.00	6.00	6.00																9.00				9.00			0.30	0.10	0.10			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3909	001	0	1	04	01	H3909_001_0	4	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					12.00	24.00	36.00					12.00	24.00	24.00																18.00				18.00			0.60	0.40	0.40			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3909	001	0	1	04	01	H3909_001_0	4	Preferred Brand	4	000001	1	2	3	1		111	01	111		1				30	60	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	100100	1	2	4	1		111	01	111		1				30	60	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	010010	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31												25	25	25					25	25	25				25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3909	009	0	1	04	01	H3909_009_0	4	Preferred Generic	4	001000	1	2	1	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					3.00	6.00	6.00																9.00				9.00			0.30	0.10	0.10			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3909	009	0	1	04	01	H3909_009_0	4	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					12.00	24.00	36.00					12.00	24.00	24.00																18.00				18.00			0.60	0.40	0.40			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3909	009	0	1	04	01	H3909_009_0	4	Preferred Brand	4	000001	1	2	3	1		111	01	111		1				30	60	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	4	Non-Preferred Drug	4	100100	1	2	4	1		111	01	111		1				30	60	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	4	Specialty Tier	4	010010	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31												25	25	25					25	25	25				25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	001	0	1	04	01	H3916_001_0	8	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	31		90				1	2			90				31		31	3.00		9.00																					7.50																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	001	0	1	04	01	H3916_001_0	8	Preferred Generic	4	001000	1	2	1	3	110		01	100		1	31		90				1	2			90				31		31	3.00		9.00																					7.50																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3916	001	0	1	04	01	H3916_001_0	8	Generic	4	010000	1	2	2	1	110		01	100		1	31		90				1	2			90				31		31	20.00		60.00																					50.00																20.00				20.00		0.65						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	001	0	1	04	01	H3916_001_0	8	Generic	4	010000	1	2	2	3	110		01	100		1	31		90				1	2			90				31		31	20.00		60.00																					50.00																20.00				20.00		0.65						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3916	001	0	1	04	01	H3916_001_0	8	Preferred Brand	4	010001	1	2	3	1	110		01	100		1	31		90				1	2			90				31		31	47.00		141.00																					117.50																47.00				47.00		1.52						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	001	0	1	04	01	H3916_001_0	8	Non-Preferred Drug	4	110000	1	1	4	1	110		01	100		1	31		90				1	2			90				31		31				90.25	45		45																				45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	001	0	1	04	01	H3916_001_0	8	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	31								31						31		31				866.29	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	002	0	1	04	01	H3916_002_0	8	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	31		90				1	2			90				31		31	3.00		9.00																					7.50																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	002	0	1	04	01	H3916_002_0	8	Preferred Generic	4	001000	1	2	1	3	110		01	100		1	31		90				1	2			90				31		31	3.00		9.00																					7.50																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3916	002	0	1	04	01	H3916_002_0	8	Generic	4	010000	1	2	2	1	110		01	100		1	31		90				1	2			90				31		31	20.00		60.00																					50.00																20.00				20.00		0.65						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	002	0	1	04	01	H3916_002_0	8	Generic	4	010000	1	2	2	3	110		01	100		1	31		90				1	2			90				31		31	20.00		60.00																					50.00																20.00				20.00		0.65						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3916	002	0	1	04	01	H3916_002_0	8	Preferred Brand	4	010001	1	2	3	1	110		01	100		1	31		90				1	2			90				31		31	47.00		141.00																					117.50																47.00				47.00		1.52						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	002	0	1	04	01	H3916_002_0	8	Non-Preferred Drug	4	110000	1	1	4	1	110		01	100		1	31		90				1	2			90				31		31				92.12	45		45																				45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	002	0	1	04	01	H3916_002_0	8	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	31								31						31		31				847.10	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	005	0	1	04	01	H3916_005_0	8	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	31		90				1	2			90				31		31	3.00		9.00																					7.50																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	005	0	1	04	01	H3916_005_0	8	Preferred Generic	4	001000	1	2	1	3	110		01	100		1	31		90				1	2			90				31		31	3.00		9.00																					7.50																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3916	005	0	1	04	01	H3916_005_0	8	Generic	4	010000	1	2	2	1	110		01	100		1	31		90				1	2			90				31		31	20.00		60.00																					50.00																20.00				20.00		0.65						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	005	0	1	04	01	H3916_005_0	8	Generic	4	010000	1	2	2	3	110		01	100		1	31		90				1	2			90				31		31	20.00		60.00																					50.00																20.00				20.00		0.65						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3916	005	0	1	04	01	H3916_005_0	8	Preferred Brand	4	010001	1	2	3	1	110		01	100		1	31		90				1	2			90				31		31	47.00		141.00																					117.50																47.00				47.00		1.52						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	005	0	1	04	01	H3916_005_0	8	Non-Preferred Drug	4	110000	1	1	4	1	110		01	100		1	31		90				1	2			90				31		31				89.88	45		45																				45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	005	0	1	04	01	H3916_005_0	8	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	31								31						31		31				913.46	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	015	0	1	04	01	H3916_015_0	8	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	31		90				1	2			90				31		31	3.00		9.00																					7.50																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	015	0	1	04	01	H3916_015_0	8	Generic	4	010000	1	2	2	1	110		01	100		1	31		90				1	2			90				31		31	20.00		60.00																					50.00																20.00				20.00		0.65						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	015	0	1	04	01	H3916_015_0	8	Preferred Brand	4	010001	1	2	3	1	110		01	100		1	31		90				1	2			90				31		31	47.00		141.00																					117.50																47.00				47.00		1.52						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	015	0	1	04	01	H3916_015_0	8	Non-Preferred Drug	4	110000	1	1	4	1	110		01	100		1	31		90				1	2			90				31		31				90.25	45		45																				45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	015	0	1	04	01	H3916_015_0	8	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	31								31						31		31				903.11	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	018	0	1	04	01	H3916_018_0	8	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	31		90				1	2			90				31		31	3.00		9.00																					7.50																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	018	0	1	04	01	H3916_018_0	8	Generic	4	010000	1	2	2	1	110		01	100		1	31		90				1	2			90				31		31	20.00		60.00																					50.00																20.00				20.00		0.65						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	018	0	1	04	01	H3916_018_0	8	Preferred Brand	4	010001	1	2	3	1	110		01	100		1	31		90				1	2			90				31		31	47.00		141.00																					117.50																47.00				47.00		1.52						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	018	0	1	04	01	H3916_018_0	8	Non-Preferred Drug	4	110000	1	1	4	1	110		01	100		1	31		90				1	2			90				31		31				93.89	45		45																				45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	018	0	1	04	01	H3916_018_0	8	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	31								31						31		31				826.74	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	022	0	1	04	01	H3916_022_0	8	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	31		90				1	2			90				31		31	3.00		9.00																					7.50																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	022	0	1	04	01	H3916_022_0	8	Generic	4	010000	1	2	2	1	110		01	100		1	31		90				1	2			90				31		31	20.00		60.00																					50.00																20.00				20.00		0.65						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	022	0	1	04	01	H3916_022_0	8	Preferred Brand	4	010001	1	2	3	1	110		01	100		1	31		90				1	2			90				31		31	47.00		141.00																					117.50																47.00				47.00		1.52						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	022	0	1	04	01	H3916_022_0	8	Non-Preferred Drug	4	110000	1	1	4	1	110		01	100		1	31		90				1	2			90				31		31				86.12	45		45																				45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	022	0	1	04	01	H3916_022_0	8	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	31								31						31		31				843.21	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	024	0	1	04	01	H3916_024_0	8	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	31		90				1	2			90				31		31	3.00		9.00																					7.50																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	024	0	1	04	01	H3916_024_0	8	Generic	4	010000	1	2	2	1	110		01	100		1	31		90				1	2			90				31		31	20.00		60.00																					50.00																20.00				20.00		0.65						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	024	0	1	04	01	H3916_024_0	8	Preferred Brand	4	010001	1	2	3	1	110		01	100		1	31		90				1	2			90				31		31	47.00		141.00																					117.50																47.00				47.00		1.52						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	024	0	1	04	01	H3916_024_0	8	Non-Preferred Drug	4	110000	1	1	4	1	110		01	100		1	31		90				1	2			90				31		31				86.91	45		45																				45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	024	0	1	04	01	H3916_024_0	8	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	31								31						31		31				879.22	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	032	0	1	04	01	H3916_032_0	8	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	31		90				1	2			90				31		31	3.00		9.00																					7.50																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	032	0	1	04	01	H3916_032_0	8	Generic	4	010000	1	2	2	1	110		01	100		1	31		90				1	2			90				31		31	20.00		60.00																					50.00																20.00				20.00		0.65						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	032	0	1	04	01	H3916_032_0	8	Preferred Brand	4	010001	1	2	3	1	110		01	100		1	31		90				1	2			90				31		31	47.00		141.00																					117.50																47.00				47.00		1.52						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	032	0	1	04	01	H3916_032_0	8	Non-Preferred Drug	4	110000	1	1	4	1	110		01	100		1	31		90				1	2			90				31		31				81.31	45		45																				45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	032	0	1	04	01	H3916_032_0	8	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	31								31						31		31				817.09	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	033	0	1	04	01	H3916_033_0	8	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	31		90				1	2			90				31		31	3.00		9.00																					7.50																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	033	0	1	04	01	H3916_033_0	8	Generic	4	010000	1	2	2	1	110		01	100		1	31		90				1	2			90				31		31	20.00		60.00																					50.00																20.00				20.00		0.65						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	033	0	1	04	01	H3916_033_0	8	Preferred Brand	4	010001	1	2	3	1	110		01	100		1	31		90				1	2			90				31		31	47.00		141.00																					117.50																47.00				47.00		1.52						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	033	0	1	04	01	H3916_033_0	8	Non-Preferred Drug	4	110000	1	1	4	1	110		01	100		1	31		90				1	2			90				31		31				86.49	45		45																				45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3916	033	0	1	04	01	H3916_033_0	8	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	31								31						31		31				890.66	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3923	013	0	1	04	01	H3923_013_0	6	Preferred Generic	4	001001	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					3.00		9.00											10.00		30.00				3.00		9.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3923	013	0	1	04	01	H3923_013_0	6	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		45.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3923	013	0	1	04	01	H3923_013_0	6	Preferred Brand	4	000101	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3923	013	0	1	04	01	H3923_013_0	6	Non-Preferred Drug	4	100100	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3923	013	0	1	04	01	H3923_013_0	6	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31											871.62	33						871.62	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3923	017	0	1	04	01	H3923_017_0	6	Preferred Generic	4	001001	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								8.00		24.00					3.00		9.00											8.00		24.00				3.00		9.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3923	017	0	1	04	01	H3923_017_0	6	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		45.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3923	017	0	1	04	01	H3923_017_0	6	Preferred Brand	4	000101	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3923	017	0	1	04	01	H3923_017_0	6	Non-Preferred Drug	4	100100	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3923	017	0	1	04	01	H3923_017_0	6	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31											500.05	33						500.05	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3924	059	3	1	04	01	H3924_059_3	4	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	3	1	04	01	H3924_059_3	4	Preferred Generic	4	001000	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3924	059	3	1	04	01	H3924_059_3	4	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	20.00		50.00																					60.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	3	1	04	01	H3924_059_3	4	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		117.50																					141.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	3	1	04	01	H3924_059_3	4	Non-Preferred Brand	4	100000	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		250.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	3	1	04	01	H3924_059_3	4	Specialty Tier	4	010010	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	4	1	04	01	H3924_059_4	5	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	4	1	04	01	H3924_059_4	5	Preferred Generic	4	001000	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3924	059	4	1	04	01	H3924_059_4	5	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	20.00		50.00																					60.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	4	1	04	01	H3924_059_4	5	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		117.50																					141.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	4	1	04	01	H3924_059_4	5	Non-Preferred Brand	4	100000	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		250.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	4	1	04	01	H3924_059_4	5	Specialty Tier	4	010010	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	6	1	04	01	H3924_059_6	5	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	6	1	04	01	H3924_059_6	5	Preferred Generic	4	001000	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3924	059	6	1	04	01	H3924_059_6	5	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	20.00		50.00																					60.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	6	1	04	01	H3924_059_6	5	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		117.50																					141.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	6	1	04	01	H3924_059_6	5	Non-Preferred Brand	4	100000	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		250.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	6	1	04	01	H3924_059_6	5	Specialty Tier	4	010010	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	7	1	04	01	H3924_059_7	5	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	7	1	04	01	H3924_059_7	5	Preferred Generic	4	001000	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3924	059	7	1	04	01	H3924_059_7	5	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	20.00		50.00																					60.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	7	1	04	01	H3924_059_7	5	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		117.50																					141.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	7	1	04	01	H3924_059_7	5	Non-Preferred Brand	4	100000	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		250.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	7	1	04	01	H3924_059_7	5	Specialty Tier	4	010010	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	8	1	04	01	H3924_059_8	5	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	8	1	04	01	H3924_059_8	5	Preferred Generic	4	001000	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3924	059	8	1	04	01	H3924_059_8	5	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	20.00		50.00																					60.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	8	1	04	01	H3924_059_8	5	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		117.50																					141.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	8	1	04	01	H3924_059_8	5	Non-Preferred Brand	4	100000	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		250.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	8	1	04	01	H3924_059_8	5	Specialty Tier	4	010010	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	9	1	04	01	H3924_059_9	5	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	9	1	04	01	H3924_059_9	5	Preferred Generic	4	001000	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3924	059	9	1	04	01	H3924_059_9	5	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	20.00		50.00																					60.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	9	1	04	01	H3924_059_9	5	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		117.50																					141.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	9	1	04	01	H3924_059_9	5	Non-Preferred Brand	4	100000	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		250.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	059	9	1	04	01	H3924_059_9	5	Specialty Tier	4	010010	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	060	3	1	04	01	H3924_060_3	4	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	060	3	1	04	01	H3924_060_3	4	Preferred Generic	4	001000	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3924	060	3	1	04	01	H3924_060_3	4	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	20.00		50.00																					60.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	060	3	1	04	01	H3924_060_3	4	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		117.50																					141.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	060	3	1	04	01	H3924_060_3	4	Non-Preferred Brand	4	100000	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		250.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	060	3	1	04	01	H3924_060_3	4	Specialty Tier	4	010010	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	060	4	1	04	01	H3924_060_4	5	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	060	4	1	04	01	H3924_060_4	5	Preferred Generic	4	001000	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3924	060	4	1	04	01	H3924_060_4	5	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	20.00		50.00																					60.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	060	4	1	04	01	H3924_060_4	5	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		117.50																					141.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	060	4	1	04	01	H3924_060_4	5	Non-Preferred Brand	4	100000	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		250.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	060	4	1	04	01	H3924_060_4	5	Specialty Tier	4	010010	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	060	6	1	04	01	H3924_060_6	5	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	060	6	1	04	01	H3924_060_6	5	Preferred Generic	4	001000	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3924	060	6	1	04	01	H3924_060_6	5	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	20.00		50.00																					60.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	060	6	1	04	01	H3924_060_6	5	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		117.50																					141.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	060	6	1	04	01	H3924_060_6	5	Non-Preferred Brand	4	100000	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		250.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	060	6	1	04	01	H3924_060_6	5	Specialty Tier	4	010010	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	060	7	1	04	01	H3924_060_7	5	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	060	7	1	04	01	H3924_060_7	5	Preferred Generic	4	001000	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3924	060	7	1	04	01	H3924_060_7	5	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	20.00		50.00																					60.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	060	7	1	04	01	H3924_060_7	5	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		117.50																					141.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	060	7	1	04	01	H3924_060_7	5	Non-Preferred Brand	4	100000	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		250.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	060	7	1	04	01	H3924_060_7	5	Specialty Tier	4	010010	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	060	8	1	04	01	H3924_060_8	5	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	060	8	1	04	01	H3924_060_8	5	Preferred Generic	4	001000	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3924	060	8	1	04	01	H3924_060_8	5	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	20.00		50.00																					60.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	060	8	1	04	01	H3924_060_8	5	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		117.50																					141.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	060	8	1	04	01	H3924_060_8	5	Non-Preferred Brand	4	100000	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		250.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	060	8	1	04	01	H3924_060_8	5	Specialty Tier	4	010010	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	060	9	1	04	01	H3924_060_9	5	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	060	9	1	04	01	H3924_060_9	5	Preferred Generic	4	001000	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3924	060	9	1	04	01	H3924_060_9	5	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	20.00		50.00																					60.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	060	9	1	04	01	H3924_060_9	5	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		117.50																					141.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	060	9	1	04	01	H3924_060_9	5	Non-Preferred Brand	4	100000	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		250.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3924	060	9	1	04	01	H3924_060_9	5	Specialty Tier	4	010010	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3928	001	0	1	01	01	H3928_001_0	5	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3928	001	0	1	01	01	H3928_001_0	5	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3928	001	0	1	01	01	H3928_001_0	5	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3928	001	0	1	01	01	H3928_001_0	5	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3928	001	0	1	01	01	H3928_001_0	5	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	5	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	5	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	31						1.00	31												31						31						31		31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3928	002	0	1	01	01	H3928_002_0	6	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3928	002	0	1	01	01	H3928_002_0	6	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3928	002	0	1	01	01	H3928_002_0	6	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3928	002	0	1	01	01	H3928_002_0	6	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3928	002	0	1	01	01	H3928_002_0	6	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	6	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	6	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	004	0	1	01	01	H3931_004_0	5	Preferred Generic	4	001010	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	004	0	1	01	01	H3931_004_0	5	Preferred Generic	4	001010	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	004	0	1	01	01	H3931_004_0	5	Generic	4	010010	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	004	0	1	01	01	H3931_004_0	5	Generic	4	010010	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	004	0	1	01	01	H3931_004_0	5	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	004	0	1	01	01	H3931_004_0	5	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	004	0	1	01	01	H3931_004_0	5	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	064	0	1	01	01	H3931_064_0	4	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	064	0	1	01	01	H3931_064_0	4	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	064	0	1	01	01	H3931_064_0	4	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	064	0	1	01	01	H3931_064_0	4	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	064	0	1	01	01	H3931_064_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	064	0	1	01	01	H3931_064_0	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	064	0	1	01	01	H3931_064_0	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	28						1.00	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	065	0	1	01	01	H3931_065_0	4	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	065	0	1	01	01	H3931_065_0	4	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	065	0	1	01	01	H3931_065_0	4	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	065	0	1	01	01	H3931_065_0	4	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	065	0	1	01	01	H3931_065_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	065	0	1	01	01	H3931_065_0	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	065	0	1	01	01	H3931_065_0	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	27						1.00	27												27						27						27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	070	0	1	01	01	H3931_070_0	5	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	070	0	1	01	01	H3931_070_0	5	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	070	0	1	01	01	H3931_070_0	5	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	070	0	1	01	01	H3931_070_0	5	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	070	0	1	01	01	H3931_070_0	5	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	5	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	5	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	31						1.00	31												31						31						31		31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	081	0	1	01	01	H3931_081_0	4	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	081	0	1	01	01	H3931_081_0	4	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	081	0	1	01	01	H3931_081_0	4	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	081	0	1	01	01	H3931_081_0	4	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	081	0	1	01	01	H3931_081_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	081	0	1	01	01	H3931_081_0	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	081	0	1	01	01	H3931_081_0	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	087	0	1	01	01	H3931_087_0	4	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	087	0	1	01	01	H3931_087_0	4	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	087	0	1	01	01	H3931_087_0	4	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	087	0	1	01	01	H3931_087_0	4	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	087	0	1	01	01	H3931_087_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	087	0	1	01	01	H3931_087_0	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	087	0	1	01	01	H3931_087_0	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	091	0	1	01	01	H3931_091_0	4	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	091	0	1	01	01	H3931_091_0	4	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	091	0	1	01	01	H3931_091_0	4	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	091	0	1	01	01	H3931_091_0	4	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	091	0	1	01	01	H3931_091_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	092	0	1	01	01	H3931_092_0	4	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	092	0	1	01	01	H3931_092_0	4	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	092	0	1	01	01	H3931_092_0	4	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	092	0	1	01	01	H3931_092_0	4	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	092	0	1	01	01	H3931_092_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	092	0	1	01	01	H3931_092_0	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	092	0	1	01	01	H3931_092_0	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	093	0	1	01	01	H3931_093_0	4	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	093	0	1	01	01	H3931_093_0	4	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	093	0	1	01	01	H3931_093_0	4	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	093	0	1	01	01	H3931_093_0	4	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	093	0	1	01	01	H3931_093_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	093	0	1	01	01	H3931_093_0	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	093	0	1	01	01	H3931_093_0	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	25						1.00	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	094	0	1	01	01	H3931_094_0	4	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	094	0	1	01	01	H3931_094_0	4	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	094	0	1	01	01	H3931_094_0	4	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	094	0	1	01	01	H3931_094_0	4	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	094	0	1	01	01	H3931_094_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	094	0	1	01	01	H3931_094_0	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	094	0	1	01	01	H3931_094_0	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	26						1.00	26												26						26						26		26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	095	0	1	01	01	H3931_095_0	5	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	095	0	1	01	01	H3931_095_0	5	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	095	0	1	01	01	H3931_095_0	5	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	095	0	1	01	01	H3931_095_0	5	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	095	0	1	01	01	H3931_095_0	5	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	095	0	1	01	01	H3931_095_0	5	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	095	0	1	01	01	H3931_095_0	5	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	25						1.00	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	096	0	1	01	01	H3931_096_0	4	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	096	0	1	01	01	H3931_096_0	4	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	096	0	1	01	01	H3931_096_0	4	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	096	0	1	01	01	H3931_096_0	4	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	096	0	1	01	01	H3931_096_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	096	0	1	01	01	H3931_096_0	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	096	0	1	01	01	H3931_096_0	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	27						1.00	27												27						27						27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	097	0	1	01	01	H3931_097_0	5	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	097	0	1	01	01	H3931_097_0	5	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	097	0	1	01	01	H3931_097_0	5	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	097	0	1	01	01	H3931_097_0	5	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	097	0	1	01	01	H3931_097_0	5	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	26						1.00	26												26						26						26		26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	098	0	1	01	01	H3931_098_0	4	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	098	0	1	01	01	H3931_098_0	4	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	098	0	1	01	01	H3931_098_0	4	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	098	0	1	01	01	H3931_098_0	4	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	098	0	1	01	01	H3931_098_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	098	0	1	01	01	H3931_098_0	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	098	0	1	01	01	H3931_098_0	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	27						1.00	27												27						27						27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	099	0	1	01	01	H3931_099_0	4	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	099	0	1	01	01	H3931_099_0	4	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	099	0	1	01	01	H3931_099_0	4	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	099	0	1	01	01	H3931_099_0	4	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	099	0	1	01	01	H3931_099_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	099	0	1	01	01	H3931_099_0	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	099	0	1	01	01	H3931_099_0	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	100	0	1	01	01	H3931_100_0	4	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	100	0	1	01	01	H3931_100_0	4	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	100	0	1	01	01	H3931_100_0	4	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	100	0	1	01	01	H3931_100_0	4	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	100	0	1	01	01	H3931_100_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	100	0	1	01	01	H3931_100_0	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	100	0	1	01	01	H3931_100_0	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	29						1.00	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	101	0	1	01	01	H3931_101_0	4	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	101	0	1	01	01	H3931_101_0	4	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	101	0	1	01	01	H3931_101_0	4	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	101	0	1	01	01	H3931_101_0	4	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	101	0	1	01	01	H3931_101_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	101	0	1	01	01	H3931_101_0	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	101	0	1	01	01	H3931_101_0	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	27						1.00	27												27						27						27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	102	0	1	01	01	H3931_102_0	4	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	102	0	1	01	01	H3931_102_0	4	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	102	0	1	01	01	H3931_102_0	4	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	102	0	1	01	01	H3931_102_0	4	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	102	0	1	01	01	H3931_102_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	104	0	1	01	01	H3931_104_0	4	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	104	0	1	01	01	H3931_104_0	4	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	104	0	1	01	01	H3931_104_0	4	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	104	0	1	01	01	H3931_104_0	4	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	104	0	1	01	01	H3931_104_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	104	0	1	01	01	H3931_104_0	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	104	0	1	01	01	H3931_104_0	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	105	0	1	01	01	H3931_105_0	4	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	105	0	1	01	01	H3931_105_0	4	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	105	0	1	01	01	H3931_105_0	4	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	105	0	1	01	01	H3931_105_0	4	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	105	0	1	01	01	H3931_105_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	105	0	1	01	01	H3931_105_0	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	105	0	1	01	01	H3931_105_0	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	106	0	1	01	01	H3931_106_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	106	0	1	01	01	H3931_106_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	106	0	1	01	01	H3931_106_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	106	0	1	01	01	H3931_106_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	106	0	1	01	01	H3931_106_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	106	0	1	01	01	H3931_106_0	3	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	106	0	1	01	01	H3931_106_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	107	0	1	01	01	H3931_107_0	4	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	107	0	1	01	01	H3931_107_0	4	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	107	0	1	01	01	H3931_107_0	4	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	107	0	1	01	01	H3931_107_0	4	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	107	0	1	01	01	H3931_107_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	107	0	1	01	01	H3931_107_0	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	107	0	1	01	01	H3931_107_0	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	29						1.00	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	108	0	1	01	01	H3931_108_0	4	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	108	0	1	01	01	H3931_108_0	4	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	108	0	1	01	01	H3931_108_0	4	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	108	0	1	01	01	H3931_108_0	4	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	108	0	1	01	01	H3931_108_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	29						1.00	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	109	0	1	01	01	H3931_109_0	5	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	109	0	1	01	01	H3931_109_0	5	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	109	0	1	01	01	H3931_109_0	5	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	109	0	1	01	01	H3931_109_0	5	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	109	0	1	01	01	H3931_109_0	5	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	109	0	1	01	01	H3931_109_0	5	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	109	0	1	01	01	H3931_109_0	5	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	29						1.00	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	110	0	1	01	01	H3931_110_0	4	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	110	0	1	01	01	H3931_110_0	4	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	110	0	1	01	01	H3931_110_0	4	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	110	0	1	01	01	H3931_110_0	4	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	110	0	1	01	01	H3931_110_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	110	0	1	01	01	H3931_110_0	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	110	0	1	01	01	H3931_110_0	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	29						1.00	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	112	0	1	01	01	H3931_112_0	4	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	112	0	1	01	01	H3931_112_0	4	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	112	0	1	01	01	H3931_112_0	4	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	112	0	1	01	01	H3931_112_0	4	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	112	0	1	01	01	H3931_112_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	112	0	1	01	01	H3931_112_0	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	112	0	1	01	01	H3931_112_0	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	27						1.00	27												27						27						27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	115	0	1	01	01	H3931_115_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	115	0	1	01	01	H3931_115_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	115	0	1	01	01	H3931_115_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	115	0	1	01	01	H3931_115_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	115	0	1	01	01	H3931_115_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	115	0	1	01	01	H3931_115_0	3	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	115	0	1	01	01	H3931_115_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	26						1.00	26												26						26						26		26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	116	0	1	01	01	H3931_116_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	116	0	1	01	01	H3931_116_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	116	0	1	01	01	H3931_116_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3931	116	0	1	01	01	H3931_116_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3931	116	0	1	01	01	H3931_116_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	116	0	1	01	01	H3931_116_0	3	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	116	0	1	01	01	H3931_116_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3945	003	0	1	02	01	H3945_003_0	5	Preferred Generic	4	001000	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		31								10.00	20.00	30.00					5.00	10.00	12.50					10.00		30.00																10.00				10.00			0.33	0.17	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3945	003	0	1	02	01	H3945_003_0	5	Generic	4	010000	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		31								15.00	30.00	45.00					10.00	20.00	25.00					15.00		45.00																15.00				15.00			0.50	0.33	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3945	003	0	1	02	01	H3945_003_0	5	Preferred Brand	4	000101	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		31								47.00	94.00	141.00					42.00	84.00	105.00					47.00		141.00																47.00				47.00			1.57	1.40	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3945	003	0	1	02	01	H3945_003_0	5	Non-Preferred Drug	4	100100	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		31								100.00	200.00	300.00					95.00	190.00	237.50					100.00		300.00																100.00				100.00			3.33	3.17	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3945	003	0	1	02	01	H3945_003_0	5	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		31											664.65	33						487.90	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	013	0	1	01	01	H3949_013_0	7	Preferred Generic	4	001000	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		31								7.00	14.00	17.50					2.00	4.00	5.00					7.00		17.50																7.00				7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	013	0	1	01	01	H3949_013_0	7	Generic	4	010000	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		31								13.00	26.00	32.50					8.00	16.00	20.00					13.00		32.50																13.00				13.00			0.43	0.27	0.43			0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	013	0	1	01	01	H3949_013_0	7	Preferred Brand	4	000101	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					47.00		141.00																47.00				47.00			1.57	1.40	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	013	0	1	01	01	H3949_013_0	7	Non-Preferred Drug	4	100100	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		31								95.00	190.00	285.00					90.00	180.00	270.00					95.00		285.00																95.00				95.00			3.17	3.00	3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	013	0	1	01	01	H3949_013_0	7	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		31											444.06	27						392.05	27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	024	0	1	01	01	H3949_024_0	5	Preferred Generic	4	001000	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		31								9.00	18.00	22.50					4.00	8.00	10.00					9.00		22.50																9.00				9.00			0.30	0.13	0.30			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H3949	024	0	1	01	01	H3949_024_0	5	Generic	4	010000	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		31								15.00	30.00	37.50					10.00	20.00	25.00					15.00		37.50																15.00				15.00			0.50	0.33	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H3949	024	0	1	01	01	H3949_024_0	5	Preferred Brand	4	000101	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					47.00		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 Diabetic Drugs												
H3949	024	0	1	01	01	H3949_024_0	5	Non-Preferred Drug	4	100100	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		31								95.00	190.00	285.00					90.00	180.00	270.00					95.00		285.00																95.00				95.00			3.17	3.00	3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H3949	024	0	1	01	01	H3949_024_0	5	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		31											456.41	27						356.17	27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H3949	024	0	1	01	01	H3949_024_0	5	Select Diabetic Drugs	4	010010	1	2	6	1		111	01	110		1				30	60	90	1	2	30		90				30		31								6.00	12.00	15.00					5.00	10.00	12.50					6.00		15.00																6.00				6.00			0.20	0.17	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H3949	028	0	1	01	01	H3949_028_0	5	Preferred Generic	4	001000	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		31								9.00	18.00	22.50					4.00	8.00	10.00					9.00		22.50																9.00				9.00			0.30	0.13	0.30			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	028	0	1	01	01	H3949_028_0	5	Generic	4	010000	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		31								15.00	30.00	37.50					10.00	20.00	25.00					15.00		37.50																15.00				15.00			0.50	0.33	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	028	0	1	01	01	H3949_028_0	5	Preferred Brand	4	000101	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					47.00		141.00																47.00				47.00			1.57	1.40	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	028	0	1	01	01	H3949_028_0	5	Non-Preferred Drug	4	100100	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		31								95.00	190.00	285.00					90.00	180.00	270.00					95.00		285.00																95.00				95.00			3.17	3.00	3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	028	0	1	01	01	H3949_028_0	5	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		31											473.44	27						407.80	27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	030	0	1	01	01	H3949_030_0	5	Preferred Generic	4	001000	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		31								9.00	18.00	22.50					4.00	8.00	10.00					9.00		22.50																9.00				9.00			0.30	0.13	0.30			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	030	0	1	01	01	H3949_030_0	5	Generic	4	010000	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		31								15.00	30.00	37.50					10.00	20.00	25.00					15.00		37.50																15.00				15.00			0.50	0.33	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	030	0	1	01	01	H3949_030_0	5	Preferred Brand	4	000101	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					47.00		141.00																47.00				47.00			1.57	1.40	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	030	0	1	01	01	H3949_030_0	5	Non-Preferred Drug	4	100100	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		31								95.00	190.00	285.00					90.00	180.00	270.00					95.00		285.00																95.00				95.00			3.17	3.00	3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3949	030	0	1	01	01	H3949_030_0	5	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		31											483.40	27						412.07	27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	020	0	1	01	01	H3952_020_0	4	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	4.00																7.00				7.00			0.23	0.07	0.07			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	020	0	1	01	01	H3952_020_0	4	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								16.00	32.00	48.00					10.00	20.00	30.00					10.00	20.00	20.00																16.00				16.00			0.53	0.33	0.33			0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	020	0	1	01	01	H3952_020_0	4	Preferred Brand	4	000001	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					47.00	94.00	141.00					47.00	94.00	94.00																47.00				47.00			1.57	1.57	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	020	0	1	01	01	H3952_020_0	4	Non-Preferred Drug	4	100100	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					100.00	200.00	300.00					100.00	200.00	200.00																100.00				100.00			3.33	3.33	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	020	0	1	01	01	H3952_020_0	4	Specialty Tier	4	010010	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	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	4.00																7.00				7.00			0.23	0.07	0.07			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	045	0	1	01	01	H3952_045_0	4	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								16.00	32.00	48.00					10.00	20.00	30.00					10.00	20.00	20.00																16.00				16.00			0.53	0.33	0.33			0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	045	0	1	01	01	H3952_045_0	4	Preferred Brand	4	000001	1	2	3	1		111	01	111		1				30	60	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	Non-Preferred Drug	4	100100	1	2	4	1		111	01	111		1				30	60	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	Specialty Tier	4	010010	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	5	Preferred Generic	4	001000	1	2	1	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					3.00	6.00	6.00																9.00				9.00			0.30	0.10	0.10			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	049	0	1	01	01	H3952_049_0	5	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					12.00	24.00	36.00					12.00	24.00	24.00																18.00				18.00			0.60	0.40	0.40			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	049	0	1	01	01	H3952_049_0	5	Preferred Brand	4	000001	1	2	3	1		111	01	111		1				30	60	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	5	Non-Preferred Drug	4	100100	1	2	4	1		111	01	111		1				30	60	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	5	Specialty Tier	4	010010	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31												25	25	25					25	25	25				25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	051	0	1	01	01	H3952_051_0	4	Preferred Generic	4	001000	1	2	1	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					3.00	6.00	6.00																9.00				9.00			0.30	0.10	0.10			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	051	0	1	01	01	H3952_051_0	4	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					12.00	24.00	36.00					12.00	24.00	24.00																18.00				18.00			0.60	0.40	0.40			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	051	0	1	01	01	H3952_051_0	4	Preferred Brand	4	000001	1	2	3	1		111	01	111		1				30	60	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	4	Non-Preferred Drug	4	100100	1	2	4	1		111	01	111		1				30	60	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	4	Specialty Tier	4	010010	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31												25	25	25					25	25	25				25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	053	0	1	01	01	H3952_053_0	4	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	4.00																7.00				7.00			0.23	0.07	0.07			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	053	0	1	01	01	H3952_053_0	4	Generic	4	010000	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												
H3952	053	0	1	01	01	H3952_053_0	4	Preferred Brand	4	000001	1	2	3	1		111	01	111		1				30	60	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	01	01	H3952_053_0	4	Non-Preferred Drug	4	100100	1	2	4	1		111	01	111		1				30	60	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	01	01	H3952_053_0	4	Specialty Tier	4	010010	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	01	01	H3952_054_0	4	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	4.00																7.00				7.00			0.23	0.07	0.07			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3952	054	0	1	01	01	H3952_054_0	4	Generic	4	010000	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												
H3952	054	0	1	01	01	H3952_054_0	4	Preferred Brand	4	000001	1	2	3	1		111	01	111		1				30	60	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	01	01	H3952_054_0	4	Non-Preferred Drug	4	100100	1	2	4	1		111	01	111		1				30	60	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	01	01	H3952_054_0	4	Specialty Tier	4	010010	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	1	1	01	01	H3954_157_1	6	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	1	1	01	01	H3954_157_1	6	Preferred Generic	4	001000	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3954	157	1	1	01	01	H3954_157_1	6	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	20.00		50.00																					60.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	1	1	01	01	H3954_157_1	6	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		117.50																					141.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	1	1	01	01	H3954_157_1	6	Non-Preferred Brand	4	100000	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		250.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	1	1	01	01	H3954_157_1	6	Specialty Tier	4	010010	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	2	1	01	01	H3954_157_2	6	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	2	1	01	01	H3954_157_2	6	Preferred Generic	4	001000	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3954	157	2	1	01	01	H3954_157_2	6	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	20.00		50.00																					60.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	2	1	01	01	H3954_157_2	6	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		117.50																					141.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	2	1	01	01	H3954_157_2	6	Non-Preferred Brand	4	100000	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		250.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	2	1	01	01	H3954_157_2	6	Specialty Tier	4	010010	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	3	1	01	01	H3954_157_3	6	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	3	1	01	01	H3954_157_3	6	Preferred Generic	4	001000	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3954	157	3	1	01	01	H3954_157_3	6	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	20.00		50.00																					60.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	3	1	01	01	H3954_157_3	6	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		117.50																					141.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	3	1	01	01	H3954_157_3	6	Non-Preferred Brand	4	100000	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		250.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	3	1	01	01	H3954_157_3	6	Specialty Tier	4	010010	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	4	1	01	01	H3954_157_4	7	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	4	1	01	01	H3954_157_4	7	Preferred Generic	4	001000	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3954	157	4	1	01	01	H3954_157_4	7	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	20.00		50.00																					60.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	4	1	01	01	H3954_157_4	7	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		117.50																					141.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	4	1	01	01	H3954_157_4	7	Non-Preferred Brand	4	100000	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		250.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	4	1	01	01	H3954_157_4	7	Specialty Tier	4	010010	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	5	1	01	01	H3954_157_5	6	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	5	1	01	01	H3954_157_5	6	Preferred Generic	4	001000	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3954	157	5	1	01	01	H3954_157_5	6	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	20.00		50.00																					60.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	5	1	01	01	H3954_157_5	6	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		117.50																					141.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	5	1	01	01	H3954_157_5	6	Non-Preferred Brand	4	100000	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		250.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	5	1	01	01	H3954_157_5	6	Specialty Tier	4	010010	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	6	1	01	01	H3954_157_6	6	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	6	1	01	01	H3954_157_6	6	Preferred Generic	4	001000	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3954	157	6	1	01	01	H3954_157_6	6	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	20.00		50.00																					60.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	6	1	01	01	H3954_157_6	6	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		117.50																					141.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	6	1	01	01	H3954_157_6	6	Non-Preferred Brand	4	100000	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		250.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	157	6	1	01	01	H3954_157_6	6	Specialty Tier	4	010010	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	1	1	01	01	H3954_158_1	6	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	1	1	01	01	H3954_158_1	6	Preferred Generic	4	001000	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3954	158	1	1	01	01	H3954_158_1	6	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	20.00		50.00																					60.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	1	1	01	01	H3954_158_1	6	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		117.50																					141.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	1	1	01	01	H3954_158_1	6	Non-Preferred Brand	4	100000	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		250.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	1	1	01	01	H3954_158_1	6	Specialty Tier	4	010010	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	2	1	01	01	H3954_158_2	6	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	2	1	01	01	H3954_158_2	6	Preferred Generic	4	001000	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3954	158	2	1	01	01	H3954_158_2	6	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	20.00		50.00																					60.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	2	1	01	01	H3954_158_2	6	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		117.50																					141.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	2	1	01	01	H3954_158_2	6	Non-Preferred Brand	4	100000	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		250.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	2	1	01	01	H3954_158_2	6	Specialty Tier	4	010010	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	3	1	01	01	H3954_158_3	6	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	3	1	01	01	H3954_158_3	6	Preferred Generic	4	001000	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3954	158	3	1	01	01	H3954_158_3	6	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	20.00		50.00																					60.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	3	1	01	01	H3954_158_3	6	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		117.50																					141.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	3	1	01	01	H3954_158_3	6	Non-Preferred Brand	4	100000	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		250.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	3	1	01	01	H3954_158_3	6	Specialty Tier	4	010010	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	4	1	01	01	H3954_158_4	6	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	4	1	01	01	H3954_158_4	6	Preferred Generic	4	001000	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3954	158	4	1	01	01	H3954_158_4	6	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	20.00		50.00																					60.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	4	1	01	01	H3954_158_4	6	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		117.50																					141.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	4	1	01	01	H3954_158_4	6	Non-Preferred Brand	4	100000	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		250.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	4	1	01	01	H3954_158_4	6	Specialty Tier	4	010010	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	5	1	01	01	H3954_158_5	6	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	5	1	01	01	H3954_158_5	6	Preferred Generic	4	001000	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3954	158	5	1	01	01	H3954_158_5	6	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	20.00		50.00																					60.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	5	1	01	01	H3954_158_5	6	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		117.50																					141.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	5	1	01	01	H3954_158_5	6	Non-Preferred Brand	4	100000	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		250.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	5	1	01	01	H3954_158_5	6	Specialty Tier	4	010010	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	6	1	01	01	H3954_158_6	6	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	6	1	01	01	H3954_158_6	6	Preferred Generic	4	001000	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3954	158	6	1	01	01	H3954_158_6	6	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	20.00		50.00																					60.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	6	1	01	01	H3954_158_6	6	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		117.50																					141.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	6	1	01	01	H3954_158_6	6	Non-Preferred Brand	4	100000	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		250.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3954	158	6	1	01	01	H3954_158_6	6	Specialty Tier	4	010010	1	1	5	1	010		01			1	30														30		31					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3957	003	0	1	01	01	H3957_003_0	8	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	31		90				1	2			90				31		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	003	0	1	01	01	H3957_003_0	8	Generic	4	010000	1	2	2	1	110		01	100		1	31		90				1	2			90				31		31	13.00		39.00																					32.50																13.00				13.00		0.42						0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	003	0	1	01	01	H3957_003_0	8	Preferred Brand	4	010001	1	2	3	1	110		01	100		1	31		90				1	2			90				31		31	44.00		132.00																					110.00																44.00				44.00		1.42						1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	003	0	1	01	01	H3957_003_0	8	Non-Preferred Drug	4	110000	1	1	4	1	110		01	100		1	31		90				1	2			90				31		31				93.40	45		45																				45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	003	0	1	01	01	H3957_003_0	8	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	31								31						31		31				782.13	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	006	0	1	01	01	H3957_006_0	8	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	31		90				1	2			90				31		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	006	0	1	01	01	H3957_006_0	8	Generic	4	010000	1	2	2	1	110		01	100		1	31		90				1	2			90				31		31	13.00		39.00																					32.50																13.00				13.00		0.42						0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	006	0	1	01	01	H3957_006_0	8	Preferred Brand	4	010001	1	2	3	1	110		01	100		1	31		90				1	2			90				31		31	44.00		132.00																					110.00																44.00				44.00		1.42						1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	006	0	1	01	01	H3957_006_0	8	Non-Preferred Drug	4	110000	1	1	4	1	110		01	100		1	31		90				1	2			90				31		31				96.17	45		45																				45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	006	0	1	01	01	H3957_006_0	8	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	31								31						31		31				809.40	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	020	0	1	01	01	H3957_020_0	8	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	31		90				1	2			90				31		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	020	0	1	01	01	H3957_020_0	8	Preferred Generic	4	001000	1	2	1	3	110		01	100		1	31		90				1	2			90				31		31	3.00		9.00																					7.50																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3957	020	0	1	01	01	H3957_020_0	8	Generic	4	010000	1	2	2	1	110		01	100		1	31		90				1	2			90				31		31	13.00		39.00																					32.50																13.00				13.00		0.42						0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	020	0	1	01	01	H3957_020_0	8	Generic	4	010000	1	2	2	3	110		01	100		1	31		90				1	2			90				31		31	13.00		39.00																					32.50																13.00				13.00		0.42						0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3957	020	0	1	01	01	H3957_020_0	8	Preferred Brand	4	010001	1	2	3	1	110		01	100		1	31		90				1	2			90				31		31	42.00		126.00																					105.00																42.00				42.00		1.35						1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	020	0	1	01	01	H3957_020_0	8	Non-Preferred Drug	4	110000	1	1	4	1	110		01	100		1	31		90				1	2			90				31		31				91.33	45		45																				45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	020	0	1	01	01	H3957_020_0	8	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	31								31						31		31				901.52	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	021	0	1	01	01	H3957_021_0	8	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	31		90				1	2			90				31		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	021	0	1	01	01	H3957_021_0	8	Preferred Generic	4	001000	1	2	1	3	110		01	100		1	31		90				1	2			90				31		31	3.00		9.00																					7.50																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3957	021	0	1	01	01	H3957_021_0	8	Generic	4	010000	1	2	2	1	110		01	100		1	31		90				1	2			90				31		31	13.00		39.00																					32.50																13.00				13.00		0.42						0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	021	0	1	01	01	H3957_021_0	8	Generic	4	010000	1	2	2	3	110		01	100		1	31		90				1	2			90				31		31	13.00		39.00																					32.50																13.00				13.00		0.42						0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3957	021	0	1	01	01	H3957_021_0	8	Preferred Brand	4	010001	1	2	3	1	110		01	100		1	31		90				1	2			90				31		31	42.00		126.00																					105.00																42.00				42.00		1.35						1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	021	0	1	01	01	H3957_021_0	8	Non-Preferred Drug	4	110000	1	1	4	1	110		01	100		1	31		90				1	2			90				31		31				94.19	45		45																				45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	021	0	1	01	01	H3957_021_0	8	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	31								31						31		31				996.58	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	031	0	1	01	01	H3957_031_0	8	Preferred Generic	4	001000	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													12.50						0.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	031	0	1	01	01	H3957_031_0	8	Generic	4	010000	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					13.00		39.00													50.00						32.50				20.00				20.00			0.65	0.42				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	031	0	1	01	01	H3957_031_0	8	Preferred Brand	4	010001	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													117.50						105.00				47.00				47.00			1.52	1.35				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	031	0	1	01	01	H3957_031_0	8	Non-Preferred Drug	4	110000	1	1	4	1		110	01		100	1				31		90	1	2						90	31		31											91.61	50		50				91.61	40		40												50						40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	031	0	1	01	01	H3957_031_0	8	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				31								31			31		31											817.24	33						817.24	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	032	0	1	01	01	H3957_032_0	8	Preferred Generic	4	001000	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													12.50						0.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	032	0	1	01	01	H3957_032_0	8	Generic	4	010000	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					13.00		39.00													50.00						32.50				20.00				20.00			0.65	0.42				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	032	0	1	01	01	H3957_032_0	8	Preferred Brand	4	010001	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													117.50						105.00				47.00				47.00			1.52	1.35				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	032	0	1	01	01	H3957_032_0	8	Non-Preferred Drug	4	110000	1	1	4	1		110	01		100	1				31		90	1	2						90	31		31											98.28	50		50				98.28	40		40												50						40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	032	0	1	01	01	H3957_032_0	8	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				31								31			31		31											771.51	33						771.51	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	038	0	1	01	01	H3957_038_0	8	Preferred Generic	4	001000	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													12.50						0.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	038	0	1	01	01	H3957_038_0	8	Generic	4	010000	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					13.00		39.00													50.00						32.50				20.00				20.00			0.65	0.42				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	038	0	1	01	01	H3957_038_0	8	Preferred Brand	4	010001	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													117.50						105.00				47.00				47.00			1.52	1.35				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	038	0	1	01	01	H3957_038_0	8	Non-Preferred Drug	4	110000	1	1	4	1		110	01		100	1				31		90	1	2						90	31		31											98.88	50		50				98.88	40		40												50						40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	038	0	1	01	01	H3957_038_0	8	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				31								31			31		31											749.97	33						749.97	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	039	0	1	01	01	H3957_039_0	8	Preferred Generic	4	001000	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	039	0	1	01	01	H3957_039_0	8	Preferred Generic	4	001000	1	2	1	3	110		01	100		1	31		90				1	2			90				31		31	3.00		9.00																					7.50																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3957	039	0	1	01	01	H3957_039_0	8	Generic	4	010000	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	039	0	1	01	01	H3957_039_0	8	Generic	4	010000	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	039	0	1	01	01	H3957_039_0	8	Preferred Brand	4	010001	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	039	0	1	01	01	H3957_039_0	8	Non-Preferred Drug	4	110000	1	1	4	1	110		01	100		1	31		90				1	2			90				31		31				90.60	45		45																				45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	039	0	1	01	01	H3957_039_0	8	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	31								31						31		31				836.31	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	040	0	1	01	01	H3957_040_0	9	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	31		90				1	2			90				31		31	5.00		15.00																					12.50																5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	040	0	1	01	01	H3957_040_0	9	Generic	4	010000	1	2	2	1	110		01	100		1	31		90				1	2			90				31		31	20.00		60.00																					50.00																20.00				20.00		0.65						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	040	0	1	01	01	H3957_040_0	9	Preferred Brand	4	010001	1	2	3	1	110		01	100		1	31		90				1	2			90				31		31	47.00		141.00																					117.50																47.00				47.00		1.52						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	040	0	1	01	01	H3957_040_0	9	Non-Preferred Drug	4	110000	1	1	4	1	110		01	100		1	31		90				1	2			90				31		31				96.27	45		45																				45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	040	0	1	01	01	H3957_040_0	9	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	31								31						31		31				834.80	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	041	0	1	01	01	H3957_041_0	9	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	31		90				1	2			90				31		31	5.00		15.00																					12.50																5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	041	0	1	01	01	H3957_041_0	9	Generic	4	010000	1	2	2	1	110		01	100		1	31		90				1	2			90				31		31	20.00		60.00																					50.00																20.00				20.00		0.65						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	041	0	1	01	01	H3957_041_0	9	Preferred Brand	4	010001	1	2	3	1	110		01	100		1	31		90				1	2			90				31		31	47.00		141.00																					117.50																47.00				47.00		1.52						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	041	0	1	01	01	H3957_041_0	9	Non-Preferred Drug	4	110000	1	1	4	1	110		01	100		1	31		90				1	2			90				31		31				89.62	45		45																				45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3957	041	0	1	01	01	H3957_041_0	9	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	31								31						31		31				631.97	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	001	0	1	01	01	H3959_001_0	6	Preferred Generic	4	001010	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	001	0	1	01	01	H3959_001_0	6	Preferred Generic	4	001010	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3959	001	0	1	01	01	H3959_001_0	6	Generic	4	010010	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	001	0	1	01	01	H3959_001_0	6	Generic	4	010010	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3959	001	0	1	01	01	H3959_001_0	6	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	001	0	1	01	01	H3959_001_0	6	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	001	0	1	01	01	H3959_001_0	6	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	002	0	1	01	01	H3959_002_0	8	Preferred Generic	4	001010	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	002	0	1	01	01	H3959_002_0	8	Preferred Generic	4	001010	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3959	002	0	1	01	01	H3959_002_0	8	Generic	4	010010	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	002	0	1	01	01	H3959_002_0	8	Generic	4	010010	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3959	002	0	1	01	01	H3959_002_0	8	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	002	0	1	01	01	H3959_002_0	8	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	002	0	1	01	01	H3959_002_0	8	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	010	0	1	01	01	H3959_010_0	6	Preferred Generic	4	001010	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	010	0	1	01	01	H3959_010_0	6	Preferred Generic	4	001010	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3959	010	0	1	01	01	H3959_010_0	6	Generic	4	010010	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	010	0	1	01	01	H3959_010_0	6	Generic	4	010010	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3959	010	0	1	01	01	H3959_010_0	6	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	010	0	1	01	01	H3959_010_0	6	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	010	0	1	01	01	H3959_010_0	6	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	011	0	1	01	01	H3959_011_0	6	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	011	0	1	01	01	H3959_011_0	6	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3959	011	0	1	01	01	H3959_011_0	6	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	011	0	1	01	01	H3959_011_0	6	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3959	011	0	1	01	01	H3959_011_0	6	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	011	0	1	01	01	H3959_011_0	6	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	011	0	1	01	01	H3959_011_0	6	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	031	0	1	01	01	H3959_031_0	6	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	031	0	1	01	01	H3959_031_0	6	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3959	031	0	1	01	01	H3959_031_0	6	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	031	0	1	01	01	H3959_031_0	6	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3959	031	0	1	01	01	H3959_031_0	6	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	031	0	1	01	01	H3959_031_0	6	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	031	0	1	01	01	H3959_031_0	6	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	26						1.00	26												26						26						26		26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	032	0	1	01	01	H3959_032_0	6	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	032	0	1	01	01	H3959_032_0	6	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3959	032	0	1	01	01	H3959_032_0	6	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	032	0	1	01	01	H3959_032_0	6	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3959	032	0	1	01	01	H3959_032_0	6	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	032	0	1	01	01	H3959_032_0	6	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	032	0	1	01	01	H3959_032_0	6	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	033	0	1	01	01	H3959_033_0	6	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	033	0	1	01	01	H3959_033_0	6	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3959	033	0	1	01	01	H3959_033_0	6	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	033	0	1	01	01	H3959_033_0	6	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3959	033	0	1	01	01	H3959_033_0	6	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	6	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	6	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	037	0	1	01	01	H3959_037_0	6	Preferred Generic	4	001010	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	037	0	1	01	01	H3959_037_0	6	Preferred Generic	4	001010	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3959	037	0	1	01	01	H3959_037_0	6	Generic	4	010010	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	037	0	1	01	01	H3959_037_0	6	Generic	4	010010	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3959	037	0	1	01	01	H3959_037_0	6	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	037	0	1	01	01	H3959_037_0	6	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	037	0	1	01	01	H3959_037_0	6	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	039	0	1	01	01	H3959_039_0	6	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	039	0	1	01	01	H3959_039_0	6	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3959	039	0	1	01	01	H3959_039_0	6	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	039	0	1	01	01	H3959_039_0	6	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3959	039	0	1	01	01	H3959_039_0	6	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	039	0	1	01	01	H3959_039_0	6	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	039	0	1	01	01	H3959_039_0	6	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	043	0	1	01	01	H3959_043_0	5	Preferred Generic	4	001010	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	043	0	1	01	01	H3959_043_0	5	Preferred Generic	4	001010	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3959	043	0	1	01	01	H3959_043_0	5	Generic	4	010010	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	043	0	1	01	01	H3959_043_0	5	Generic	4	010010	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3959	043	0	1	01	01	H3959_043_0	5	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	043	0	1	01	01	H3959_043_0	5	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	043	0	1	01	01	H3959_043_0	5	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	044	0	1	01	01	H3959_044_0	5	Preferred Generic	4	001010	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	044	0	1	01	01	H3959_044_0	5	Preferred Generic	4	001010	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3959	044	0	1	01	01	H3959_044_0	5	Generic	4	010010	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	044	0	1	01	01	H3959_044_0	5	Generic	4	010010	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3959	044	0	1	01	01	H3959_044_0	5	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	044	0	1	01	01	H3959_044_0	5	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	044	0	1	01	01	H3959_044_0	5	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	045	0	1	01	01	H3959_045_0	5	Preferred Generic	4	001010	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	045	0	1	01	01	H3959_045_0	5	Preferred Generic	4	001010	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3959	045	0	1	01	01	H3959_045_0	5	Generic	4	010010	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	045	0	1	01	01	H3959_045_0	5	Generic	4	010010	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3959	045	0	1	01	01	H3959_045_0	5	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	045	0	1	01	01	H3959_045_0	5	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	045	0	1	01	01	H3959_045_0	5	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	046	0	1	01	01	H3959_046_0	5	Preferred Generic	4	001010	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	046	0	1	01	01	H3959_046_0	5	Preferred Generic	4	001010	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3959	046	0	1	01	01	H3959_046_0	5	Generic	4	010010	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	046	0	1	01	01	H3959_046_0	5	Generic	4	010010	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3959	046	0	1	01	01	H3959_046_0	5	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	046	0	1	01	01	H3959_046_0	5	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	046	0	1	01	01	H3959_046_0	5	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	047	0	1	01	01	H3959_047_0	5	Preferred Generic	4	001010	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	047	0	1	01	01	H3959_047_0	5	Preferred Generic	4	001010	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3959	047	0	1	01	01	H3959_047_0	5	Generic	4	010010	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	047	0	1	01	01	H3959_047_0	5	Generic	4	010010	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3959	047	0	1	01	01	H3959_047_0	5	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	047	0	1	01	01	H3959_047_0	5	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3959	047	0	1	01	01	H3959_047_0	5	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3962	001	0	1	01	01	H3962_001_0	6	Preferred Generic	4	001001	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								8.00		24.00					3.00		9.00											8.00		24.00				3.00		9.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3962	001	0	1	01	01	H3962_001_0	6	Preferred Generic	4	001001	1	2	1	3		110	01		110	1				30		90	1	2				30		90	30		31								8.00		24.00					3.00		9.00											8.00		24.00				3.00		9.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3962	001	0	1	01	01	H3962_001_0	6	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					10.00		30.00											15.00		45.00				10.00		30.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3962	001	0	1	01	01	H3962_001_0	6	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	1	2				30		90	30		31								15.00		45.00					10.00		30.00											15.00		45.00				10.00		30.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H3962	001	0	1	01	01	H3962_001_0	6	Preferred Brand	4	000101	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3962	001	0	1	01	01	H3962_001_0	6	Non-Preferred Drug	4	100100	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3962	001	0	1	01	01	H3962_001_0	6	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31											387.14	33						387.14	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3962	004	0	1	01	01	H3962_004_0	7	Preferred Generic	4	001001	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								9.00		27.00					4.00		12.00											9.00		27.00				4.00		12.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3962	004	0	1	01	01	H3962_004_0	7	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								17.00		51.00					12.00		36.00											17.00		51.00				12.00		36.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3962	004	0	1	01	01	H3962_004_0	7	Preferred Brand	4	000101	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3962	004	0	1	01	01	H3962_004_0	7	Non-Preferred Drug	4	100100	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3962	004	0	1	01	01	H3962_004_0	7	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31											679.03	33						679.03	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3962	007	0	1	01	01	H3962_007_0	6	Preferred Generic	4	001001	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								10.00		30.00					3.00		9.00											10.00		30.00				3.00		9.00				10.00				10.00			0.33	0.10		0.33	0.10	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3962	007	0	1	01	01	H3962_007_0	6	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		45.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3962	007	0	1	01	01	H3962_007_0	6	Preferred Brand	4	000101	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3962	007	0	1	01	01	H3962_007_0	6	Non-Preferred Drug	4	100100	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		285.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3962	007	0	1	01	01	H3962_007_0	6	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31											945.58	33						945.58	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H3979	001	0	1	01	01	H3979_001_0	7	Preferred Generic	4	001000	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							27.00																9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3979	001	0	1	01	01	H3979_001_0	7	Preferred Generic	4	001000	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							27.00																9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3979	001	0	1	01	01	H3979_001_0	7	Generic	4	010010	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								15.00		45.00					6.00		18.00							45.00																15.00				15.00			0.50	0.20				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3979	001	0	1	01	01	H3979_001_0	7	Generic	4	010010	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								15.00		45.00					6.00		18.00							45.00																15.00				15.00			0.50	0.20				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3979	001	0	1	01	01	H3979_001_0	7	Preferred Brand	4	010001	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					39.00		117.00							141.00																47.00				47.00			1.57	1.30				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3979	001	0	1	01	01	H3979_001_0	7	Non-Preferred Brand	4	110000	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								99.00		297.00					85.00		255.00							297.00																99.00				99.00			3.30	2.83				3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3979	001	0	1	01	01	H3979_001_0	7	Specialty Tier	4	010010	1	1	5	1		110	01	100		1				30		90	1	2			90				30		31											602.55	33		33				608.74	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3979	002	0	1	02	01	H3979_002_0	7	Preferred Generic	4	001000	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							27.00																9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3979	002	0	1	02	01	H3979_002_0	7	Preferred Generic	4	001000	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							27.00																9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3979	002	0	1	02	01	H3979_002_0	7	Generic	4	010010	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								15.00		45.00					6.00		18.00							45.00																15.00				15.00			0.50	0.20				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3979	002	0	1	02	01	H3979_002_0	7	Generic	4	010010	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								15.00		45.00					6.00		18.00							45.00																15.00				15.00			0.50	0.20				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H3979	002	0	1	02	01	H3979_002_0	7	Preferred Brand	4	010001	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					39.00		117.00							141.00																47.00				47.00			1.57	1.30				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3979	002	0	1	02	01	H3979_002_0	7	Non-Preferred Brand	4	110000	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								99.00		297.00					85.00		255.00							297.00																99.00				99.00			3.30	2.83				3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H3979	002	0	1	02	01	H3979_002_0	7	Specialty Tier	4	010010	1	1	5	1		110	01	100		1				30		90	1	2			90				30		31											698.12	33		33				681.53	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	009	0	1	01	01	H4003_009_0	13	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	3.00		9.00																					6.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	009	0	1	01	01	H4003_009_0	13	Preferred Generic	4	001000	1	2	1	3	110		01	100		1	30		90				2	2			90				30		31	3.00		9.00																					6.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H4003	009	0	1	01	01	H4003_009_0	13	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	7.00		21.00																					14.00																7.00				7.00		0.23						0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	009	0	1	01	01	H4003_009_0	13	Generic	4	010000	1	2	2	3	110		01	100		1	30		90				2	2			90				30		31	7.00		21.00																					14.00																7.00				7.00		0.23						0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H4003	009	0	1	01	01	H4003_009_0	13	Preferred Brand	4	000001	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 Brand, Specialty Tier												
H4003	009	0	1	01	01	H4003_009_0	13	Non-Preferred Brand	4	100000	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	45.00		135.00																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	009	0	1	01	01	H4003_009_0	13	Specialty Tier	4	010010	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31				952.79	33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	019	0	1	01	01	H4003_019_0	13	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	019	0	1	01	01	H4003_019_0	13	Preferred Generic	4	001000	1	2	1	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H4003	019	0	1	01	01	H4003_019_0	13	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	5.00		15.00																					10.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	019	0	1	01	01	H4003_019_0	13	Generic	4	010000	1	2	2	3	110		01	100		1	30		90				2	2			90				30		31	5.00		15.00																					10.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H4003	019	0	1	01	01	H4003_019_0	13	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	18.00		54.00																					36.00																18.00				18.00		0.60						0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	019	0	1	01	01	H4003_019_0	13	Non-Preferred Brand	4	100000	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	30.00		90.00																					60.00																30.00				30.00		1.00						0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	019	0	1	01	01	H4003_019_0	13	Specialty Tier	4	010010	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31				721.81	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	027	0	1	02	01	H4003_027_0	14	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	2.00		6.00																					4.00																2.00				2.00		0.07						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4003	027	0	1	02	01	H4003_027_0	14	Preferred Generic	4	001000	1	2	1	3	110		01	100		1	30		90				2	2			90				30		31	2.00		6.00																					4.00																2.00				2.00		0.07						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		
H4003	027	0	1	02	01	H4003_027_0	14	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	7.00		21.00																					14.00																7.00				7.00		0.23						0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4003	027	0	1	02	01	H4003_027_0	14	Generic	4	010000	1	2	2	3	110		01	100		1	30		90				2	2			90				30		31	7.00		21.00																					14.00																7.00				7.00		0.23						0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		
H4003	027	0	1	02	01	H4003_027_0	14	Preferred Brand	4	000001	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												
H4003	027	0	1	02	01	H4003_027_0	14	Non-Preferred Drug	4	100100	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	65.00		195.00																					130.00																65.00				65.00		2.17						2.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4003	027	0	1	02	01	H4003_027_0	14	Specialty Tier	4	010010	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31				952.79	33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4003	034	0	1	02	01	H4003_034_0	13	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	1.00		3.00																					2.00																1.00				1.00		0.03						0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	034	0	1	02	01	H4003_034_0	13	Preferred Generic	4	001000	1	2	1	3	110		01	100		1	30		90				2	2			90				30		31	1.00		3.00																					2.00																1.00				1.00		0.03						0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H4003	034	0	1	02	01	H4003_034_0	13	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	6.00		18.00																					12.00																6.00				6.00		0.20						0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	034	0	1	02	01	H4003_034_0	13	Generic	4	010000	1	2	2	3	110		01	100		1	30		90				2	2			90				30		31	6.00		18.00																					12.00																6.00				6.00		0.20						0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H4003	034	0	1	02	01	H4003_034_0	13	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	20.00		60.00																					40.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	034	0	1	02	01	H4003_034_0	13	Non-Preferred Brand	4	100000	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	30.00		90.00																					60.00																30.00				30.00		1.00						0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4003	034	0	1	02	01	H4003_034_0	13	Specialty Tier	4	010010	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31				952.79	33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4004	056	0	1	01	01	H4004_056_0	15	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	4.00		12.00																					8.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4004	056	0	1	01	01	H4004_056_0	15	Preferred Generic	4	001000	1	2	1	3	110		01	100		1	30		90				2	2			90				30		31	4.00		12.00																					8.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		
H4004	056	0	1	01	01	H4004_056_0	15	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	8.00		24.00																					16.00																8.00				8.00		0.27						0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4004	056	0	1	01	01	H4004_056_0	15	Generic	4	010000	1	2	2	3	110		01	100		1	30		90				2	2			90				30		31	8.00		24.00																					16.00																8.00				8.00		0.27						0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2		
H4004	056	0	1	01	01	H4004_056_0	15	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	25.00		75.00																					50.00																25.00				25.00		0.83						0.81	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4004	056	0	1	01	01	H4004_056_0	15	Non-Preferred Drug	4	100100	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	40.00		120.00																					80.00																40.00				40.00		1.33						1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4004	056	0	1	01	01	H4004_056_0	15	Specialty Tier	4	010010	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31				923.92	32		32																				32															32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4005	004	0	1	04	01	H4005_004_0	11	Preferred Generic	4	001000	3	2	1	1		110	01	100		1				30		90	1	2			90				30		31								10.00		20.00					5.00		10.00							10.00																10.00				5.00			0.33	0.17				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4005	004	0	1	04	01	H4005_004_0	11	Preferred Generic	4	001000	3	2	1	3		110	01	100		1				30		90	1	2			90				30		31								10.00		20.00					5.00		10.00							10.00																10.00				5.00			0.33	0.17				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H4005	004	0	1	04	01	H4005_004_0	11	Generic	4	010000	3	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		40.00					10.00		20.00							20.00																20.00				10.00			0.67	0.33				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4005	004	0	1	04	01	H4005_004_0	11	Generic	4	010000	3	2	2	3		110	01	100		1				30		90	1	2			90				30		31								20.00		40.00					10.00		20.00							20.00																20.00				10.00			0.67	0.33				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H4005	004	0	1	04	01	H4005_004_0	11	Preferred Brand	4	000101	3	2	3	1		110	01	100		1				30		90	1	2			90				30		31								45.00		90.00					25.00		50.00							50.00																45.00				25.00			1.50	0.83				0.81	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4005	004	0	1	04	01	H4005_004_0	11	Non-Preferred Brand	4	100100	3	2	4	1		110	01	100		1				30		90	1	1			90				30		31								75.00		150.00					40.00		80.00							80.00																75.00				40.00			2.50	1.33				1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4005	004	0	1	04	01	H4005_004_0	11	Specialty Tier	4	100100	1	1	5	1		110	01	100		1				30		90	1	1			90				30		31											33.00	33		33				25.00	25		25						25															33			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4007	012	0	1	01	01	H4007_012_0	6	Preferred Generic	4	001010	1	2	1	1	110		01		110	1	30		90				2	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												
H4007	012	0	1	01	01	H4007_012_0	6	Preferred Generic	4	001010	1	2	1	3	110		01		110	1	30		90				2	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										2	3	
H4007	012	0	1	01	01	H4007_012_0	6	Generic	4	010001	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	9.00		27.00																									9.00		27.00				9.00		0.00				9.00				9.00		0.30				0.30	0.30	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4007	012	0	1	01	01	H4007_012_0	6	Generic	4	010001	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	9.00		27.00																									9.00		27.00				9.00		0.00				9.00				9.00		0.30				0.30	0.30	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H4007	012	0	1	01	01	H4007_012_0	6	Preferred Brand	4	010001	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	37.00		111.00																									37.00		111.00				37.00		101.00				37.00				37.00		1.23				1.23	1.23	1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4007	012	0	1	01	01	H4007_012_0	6	Preferred Brand	4	010001	1	2	3	3	110		01		110	1	30		90				2	2				30		90	30		31	37.00		111.00																									37.00		111.00				37.00		101.00				37.00				37.00		1.23				1.23	1.23	1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H4007	012	0	1	01	01	H4007_012_0	6	Non-Preferred Drug	4	110000	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	82.00		246.00																									82.00		246.00				82.00		236.00				82.00				82.00		2.73				2.73	2.73	2.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4007	012	0	1	01	01	H4007_012_0	6	Non-Preferred Drug	4	110000	1	2	4	3	110		01		110	1	30		90				2	2				30		90	30		31	82.00		246.00																									82.00		246.00				82.00		236.00				82.00				82.00		2.73				2.73	2.73	2.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H4007	012	0	1	01	01	H4007_012_0	6	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4007	012	0	1	01	01	H4007_012_0	6	Specialty Tier	4	010010	1	1	5	3	010		01		010	1	30											30			30		31					31																										31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H4007	013	0	1	01	01	H4007_013_0	5	Preferred Generic	4	001010	1	2	1	1	110		01		110	1	30		90				2	2				30		90	30		31	1.00		3.00																									1.00		3.00				1.00		0.00				1.00				1.00		0.03				0.03	0.03	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4007	013	0	1	01	01	H4007_013_0	5	Preferred Generic	4	001010	1	2	1	3	110		01		110	1	30		90				2	2				30		90	30		31	1.00		3.00																									1.00		3.00				1.00		0.00				1.00				1.00		0.03				0.03	0.03	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H4007	013	0	1	01	01	H4007_013_0	5	Generic	4	010001	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	4.00		12.00																									4.00		12.00				4.00		0.00				4.00				4.00		0.13				0.13	0.13	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4007	013	0	1	01	01	H4007_013_0	5	Generic	4	010001	1	2	2	3	110		01		110	1	30		90				2	2				30		90	30		31	4.00		12.00																									4.00		12.00				4.00		0.00				4.00				4.00		0.13				0.13	0.13	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H4007	013	0	1	01	01	H4007_013_0	5	Preferred Brand	4	010001	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	35.00		105.00																									35.00		105.00				35.00		95.00				35.00				35.00		1.17				1.17	1.17	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4007	013	0	1	01	01	H4007_013_0	5	Preferred Brand	4	010001	1	2	3	3	110		01		110	1	30		90				2	2				30		90	30		31	35.00		105.00																									35.00		105.00				35.00		95.00				35.00				35.00		1.17				1.17	1.17	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H4007	013	0	1	01	01	H4007_013_0	5	Non-Preferred Drug	4	110000	1	2	4	1	110		01		110	1	30		90				2	2				30		90	30		31	40.00		120.00																									40.00		120.00				40.00		110.00				40.00				40.00		1.33				1.33	1.33	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4007	013	0	1	01	01	H4007_013_0	5	Non-Preferred Drug	4	110000	1	2	4	3	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										2	3	
H4007	013	0	1	01	01	H4007_013_0	5	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31					33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4007	013	0	1	01	01	H4007_013_0	5	Specialty Tier	4	010010	1	1	5	3	010		01		010	1	30											30			30		31					31																										31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H4007	016	0	1	01	01	H4007_016_0	9	Preferred Generic	3	001010	1	1	1	1	110		01	110		1	30		90				2	2	30		90				30		31				2.00	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4007	016	0	1	01	01	H4007_016_0	9	Generic	3	010001	1	1	2	1	110		01	110		1	30		90				2	2	30		90				30		31				5.00	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4007	016	0	1	01	01	H4007_016_0	9	Preferred Brand	3	010001	1	1	3	1	110		01	110		1	30		90				2	2	30		90				30		31				42.00	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4007	016	0	1	01	01	H4007_016_0	9	Non-Preferred Drug	3	110000	1	1	4	1	110		01	110		1	30		90				2	2	30		90				30		31				45.00	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4007	016	0	1	01	01	H4007_016_0	9	Specialty Tier	3	010010	1	1	5	1	010		01	010		1	30								30						30		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4007	018	0	1	01	01	H4007_018_0	7	Preferred Generic	3	001010	1	1	1	1	110		01	110		1	30		90				2	2	30		90				30		31				2.00	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4007	018	0	1	01	01	H4007_018_0	7	Generic	3	010001	1	1	2	1	110		01	110		1	30		90				2	2	30		90				30		31				5.00	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4007	018	0	1	01	01	H4007_018_0	7	Preferred Brand	3	010001	1	1	3	1	110		01	110		1	30		90				2	2	30		90				30		31				42.00	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4007	018	0	1	01	01	H4007_018_0	7	Non-Preferred Drug	3	110000	1	1	4	1	110		01	110		1	30		90				2	2	30		90				30		31				45.00	25		25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4007	018	0	1	01	01	H4007_018_0	7	Specialty Tier	3	010010	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												
H4036	008	0	1	04	01	H4036_008_0	7	Preferred Generic	4	001000	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												
H4036	008	0	1	04	01	H4036_008_0	7	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	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												
H4036	008	0	1	04	01	H4036_008_0	7	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	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												
H4036	008	0	1	04	01	H4036_008_0	7	Non-Preferred Drug	4	100100	1	2	4	1		111	01	111		1				30	60	90	1	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												
H4036	008	0	1	04	01	H4036_008_0	7	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4036	008	0	1	04	01	H4036_008_0	7	Select Care Drugs	4	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4036	008	0	1	04	01	H4036_008_0	7	Select Care Drugs	4	001000	1	2	6	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		
H4036	009	0	1	04	01	H4036_009_0	5	Preferred Generic	4	001000	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												
H4036	009	0	1	04	01	H4036_009_0	5	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	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												
H4036	009	0	1	04	01	H4036_009_0	5	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	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												
H4036	009	0	1	04	01	H4036_009_0	5	Non-Preferred Drug	4	100100	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												
H4036	009	0	1	04	01	H4036_009_0	5	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		34												32							32						32																	32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4036	009	0	1	04	01	H4036_009_0	5	Select Care Drugs	4	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4036	009	0	1	04	01	H4036_009_0	5	Select Care Drugs	4	001000	1	2	6	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		
H4036	010	1	1	04	01	H4036_010_1	6	Preferred Generic	4	001000	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												
H4036	010	1	1	04	01	H4036_010_1	6	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	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												
H4036	010	1	1	04	01	H4036_010_1	6	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	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												
H4036	010	1	1	04	01	H4036_010_1	6	Non-Preferred Drug	4	100100	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												
H4036	010	1	1	04	01	H4036_010_1	6	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		34												32							32						32																	32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4036	010	1	1	04	01	H4036_010_1	6	Select Care Drugs	4	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4036	010	1	1	04	01	H4036_010_1	6	Select Care Drugs	4	001000	1	2	6	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		
H4036	010	2	1	04	01	H4036_010_2	6	Preferred Generic	4	001000	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												
H4036	010	2	1	04	01	H4036_010_2	6	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	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												
H4036	010	2	1	04	01	H4036_010_2	6	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	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												
H4036	010	2	1	04	01	H4036_010_2	6	Non-Preferred Drug	4	100100	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												
H4036	010	2	1	04	01	H4036_010_2	6	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		34												32							32						32																	32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4036	010	2	1	04	01	H4036_010_2	6	Select Care Drugs	4	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4036	010	2	1	04	01	H4036_010_2	6	Select Care Drugs	4	001000	1	2	6	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		
H4036	012	1	1	04	01	H4036_012_1	6	Preferred Generic	4	001000	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												
H4036	012	1	1	04	01	H4036_012_1	6	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	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												
H4036	012	1	1	04	01	H4036_012_1	6	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	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												
H4036	012	1	1	04	01	H4036_012_1	6	Non-Preferred Drug	4	100100	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												
H4036	012	1	1	04	01	H4036_012_1	6	Specialty Tier	4	010010	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	012	1	1	04	01	H4036_012_1	6	Select Care Drugs	4	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4036	012	1	1	04	01	H4036_012_1	6	Select Care Drugs	4	001000	1	2	6	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		
H4036	012	2	1	04	01	H4036_012_2	6	Preferred Generic	4	001000	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												
H4036	012	2	1	04	01	H4036_012_2	6	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	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												
H4036	012	2	1	04	01	H4036_012_2	6	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	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												
H4036	012	2	1	04	01	H4036_012_2	6	Non-Preferred Drug	4	100100	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												
H4036	012	2	1	04	01	H4036_012_2	6	Specialty Tier	4	010010	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	012	2	1	04	01	H4036_012_2	6	Select Care Drugs	4	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4036	012	2	1	04	01	H4036_012_2	6	Select Care Drugs	4	001000	1	2	6	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		
H4141	001	0	1	01	01	H4141_001_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4141	001	0	1	01	01	H4141_001_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H4141	001	0	1	01	01	H4141_001_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4141	001	0	1	01	01	H4141_001_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H4141	001	0	1	01	01	H4141_001_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4141	001	0	1	01	01	H4141_001_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H4141	001	0	1	01	01	H4141_001_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4141	001	0	1	01	01	H4141_001_0	4	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H4141	001	0	1	01	01	H4141_001_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4141	001	0	1	01	01	H4141_001_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H4141	003	0	1	01	01	H4141_003_0	5	Preferred Generic	3	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4141	003	0	1	01	01	H4141_003_0	5	Generic	3	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								17.00		51.00					12.00		36.00											17.00		51.00				12.00		0.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4141	003	0	1	01	01	H4141_003_0	5	Preferred Brand	3	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4141	003	0	1	01	01	H4141_003_0	5	Non-Preferred Drug	3	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4141	003	0	1	01	01	H4141_003_0	5	Specialty Tier	3	010010	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												
H4141	004	0	1	01	01	H4141_004_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4141	004	0	1	01	01	H4141_004_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H4141	004	0	1	01	01	H4141_004_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4141	004	0	1	01	01	H4141_004_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H4141	004	0	1	01	01	H4141_004_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4141	004	0	1	01	01	H4141_004_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H4141	004	0	1	01	01	H4141_004_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4141	004	0	1	01	01	H4141_004_0	4	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H4141	004	0	1	01	01	H4141_004_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4141	004	0	1	01	01	H4141_004_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H4141	015	0	1	01	01	H4141_015_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4141	015	0	1	01	01	H4141_015_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H4141	015	0	1	01	01	H4141_015_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4141	015	0	1	01	01	H4141_015_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H4141	015	0	1	01	01	H4141_015_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4141	015	0	1	01	01	H4141_015_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H4141	015	0	1	01	01	H4141_015_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4141	015	0	1	01	01	H4141_015_0	4	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H4141	015	0	1	01	01	H4141_015_0	4	Specialty Tier	4	010010	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												
H4141	015	0	1	01	01	H4141_015_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H4145	001	0	1	01	01	H4145_001_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4145	001	0	1	01	01	H4145_001_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H4145	001	0	1	01	01	H4145_001_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								16.00		48.00					11.00		33.00											16.00		48.00				11.00		0.00				16.00				16.00			0.53	0.37		0.53	0.37	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4145	001	0	1	01	01	H4145_001_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								16.00		48.00					11.00		33.00											16.00		48.00				11.00		0.00				16.00				16.00			0.53	0.37		0.53	0.37	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H4145	001	0	1	01	01	H4145_001_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4145	001	0	1	01	01	H4145_001_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H4145	001	0	1	01	01	H4145_001_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4145	001	0	1	01	01	H4145_001_0	4	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H4145	001	0	1	01	01	H4145_001_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4145	001	0	1	01	01	H4145_001_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H4145	002	0	1	01	01	H4145_002_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4145	002	0	1	01	01	H4145_002_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H4145	002	0	1	01	01	H4145_002_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								16.00		48.00					11.00		33.00											16.00		48.00				11.00		0.00				16.00				16.00			0.53	0.37		0.53	0.37	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4145	002	0	1	01	01	H4145_002_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								16.00		48.00					11.00		33.00											16.00		48.00				11.00		0.00				16.00				16.00			0.53	0.37		0.53	0.37	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H4145	002	0	1	01	01	H4145_002_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4145	002	0	1	01	01	H4145_002_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H4145	002	0	1	01	01	H4145_002_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4145	002	0	1	01	01	H4145_002_0	4	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H4145	002	0	1	01	01	H4145_002_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4145	002	0	1	01	01	H4145_002_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H4152	005	0	1	01	01	H4152_005_0	11	Preferred Generic	4	001000	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	3.00	3.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4152	005	0	1	01	01	H4152_005_0	11	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	6.00	12.00	18.00																			6.00	6.00	6.00																6.00				6.00		0.20			0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4152	005	0	1	01	01	H4152_005_0	11	Preferred Brand	4	010001	1	2	3	1	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 Brand, Specialty Tier												
H4152	005	0	1	01	01	H4152_005_0	11	Non-Preferred Brand	4	110000	1	2	4	1	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 Brand, Specialty Tier												
H4152	005	0	1	01	01	H4152_005_0	11	Specialty Tier	4	010010	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												
H4152	007	0	1	02	01	H4152_007_0	11	Preferred Generic	4	001000	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	3.00	3.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4152	007	0	1	02	01	H4152_007_0	11	Preferred Generic	4	001000	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	9.00																			3.00	3.00	3.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4152	007	0	1	02	01	H4152_007_0	11	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	6.00	12.00	18.00																			6.00	6.00	6.00																6.00				6.00		0.20			0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4152	007	0	1	02	01	H4152_007_0	11	Generic	4	010000	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	6.00	12.00	18.00																			6.00	6.00	6.00																6.00				6.00		0.20			0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4152	007	0	1	02	01	H4152_007_0	11	Preferred Brand	4	010001	1	2	3	1	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 Brand, Specialty Tier												
H4152	007	0	1	02	01	H4152_007_0	11	Non-Preferred Brand	4	110000	1	2	4	1	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 Brand, Specialty Tier												
H4152	007	0	1	02	01	H4152_007_0	11	Specialty Tier	4	010010	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												
H4152	013	0	1	01	01	H4152_013_0	11	Preferred Generic	4	001000	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 Brand, Specialty Tier												
H4152	013	0	1	01	01	H4152_013_0	11	Generic	4	010000	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	8.00	8.00																8.00				8.00		0.27			0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4152	013	0	1	01	01	H4152_013_0	11	Preferred Brand	4	010001	1	2	3	1	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 Brand, Specialty Tier												
H4152	013	0	1	01	01	H4152_013_0	11	Non-Preferred Brand	4	110000	1	2	4	1	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 Brand, Specialty Tier												
H4152	013	0	1	01	01	H4152_013_0	11	Specialty Tier	4	010010	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												
H4152	016	0	1	02	01	H4152_016_0	11	Preferred Generic	4	001000	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	3.00	3.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4152	016	0	1	02	01	H4152_016_0	11	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	30.00																			10.00	10.00	10.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4152	016	0	1	02	01	H4152_016_0	11	Preferred Brand	4	010001	1	2	3	1	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 Brand, Specialty Tier												
H4152	016	0	1	02	01	H4152_016_0	11	Non-Preferred Brand	4	110000	1	2	4	1	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 Brand, Specialty Tier												
H4152	016	0	1	02	01	H4152_016_0	11	Specialty Tier	4	010010	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												
H4152	017	0	1	01	01	H4152_017_0	11	Preferred Generic	4	001000	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	2.00	2.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4152	017	0	1	01	01	H4152_017_0	11	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	30.00																			10.00	10.00	10.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4152	017	0	1	01	01	H4152_017_0	11	Preferred Brand	4	010001	1	2	3	1	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 Brand, Specialty Tier												
H4152	017	0	1	01	01	H4152_017_0	11	Non-Preferred Brand	4	110000	1	2	4	1	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 Brand, Specialty Tier												
H4152	017	0	1	01	01	H4152_017_0	11	Specialty Tier	4	010010	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												
H4152	018	0	1	02	01	H4152_018_0	11	Preferred Generic	4	001000	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 Brand, Specialty Tier												
H4152	018	0	1	02	01	H4152_018_0	11	Generic	4	010000	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	8.00	8.00																8.00				8.00		0.27			0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4152	018	0	1	02	01	H4152_018_0	11	Preferred Brand	4	010001	1	2	3	1	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 Brand, Specialty Tier												
H4152	018	0	1	02	01	H4152_018_0	11	Non-Preferred Brand	4	110000	1	2	4	1	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 Brand, Specialty Tier												
H4152	018	0	1	02	01	H4152_018_0	11	Specialty Tier	4	010010	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												
H4198	003	0	1	01	01	H4198_003_0	9	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H4198	003	0	1	01	01	H4198_003_0	9	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	12.00	24.00	36.00																			12.00	24.00	24.00																12.00				12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H4198	003	0	1	01	01	H4198_003_0	9	Preferred Brand	4	000001	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	40.00	80.00	120.00																			40.00	80.00	80.00																40.00				40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H4198	003	0	1	01	01	H4198_003_0	9	Non-Preferred Brand	4	100100	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 Brand, Injectable Drugs, Specialty Tier												
H4198	003	0	1	01	01	H4198_003_0	9	Injectable Drugs	4	100100	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				94.63	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H4198	003	0	1	01	01	H4198_003_0	9	Specialty Tier	4	100100	1	1	6	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 Brand, Injectable Drugs, Specialty Tier												
H4198	005	0	1	01	01	H4198_005_0	8	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	15.00																			5.00	10.00	10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H4198	005	0	1	01	01	H4198_005_0	8	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	13.00	26.00	39.00																			13.00	26.00	26.00																13.00				13.00		0.43			0.43			0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H4198	005	0	1	01	01	H4198_005_0	8	Preferred Brand	4	000001	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	40.00	80.00	120.00																			40.00	80.00	80.00																40.00				40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H4198	005	0	1	01	01	H4198_005_0	8	Non-Preferred Brand	4	100100	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	90.00	180.00	270.00																			90.00	180.00	180.00																90.00				90.00		3.00			3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H4198	005	0	1	01	01	H4198_005_0	8	Injectable Drugs	4	100100	1	1	5	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				79.92	33	33	33																		33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H4198	005	0	1	01	01	H4198_005_0	8	Specialty Tier	4	100100	1	1	6	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 Brand, Injectable Drugs, Specialty Tier												
H4213	017	1	1	09	04	H4213_017_1	6	Preferred Generic	3	001000	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								10.00		25.00					3.00		7.50					3.00		7.50																10.00				3.00			0.33	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4213	017	1	1	09	04	H4213_017_1	6	Generic	3	010000	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								20.00		50.00					13.00		32.50					13.00		32.50																20.00				13.00			0.67	0.43	0.43			0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4213	017	1	1	09	04	H4213_017_1	6	Preferred Brand	3	000001	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		117.50					42.00		105.00					42.00		105.00																47.00				42.00			1.57	1.40	1.40			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4213	017	1	1	09	04	H4213_017_1	6	Non-Preferred Brand	3	110000	1	2	4	1		110	01	110		1				30		90	1	2	30		90				30		31								100.00		250.00					95.00		237.50					95.00		237.50																100.00				95.00			3.33	3.17	3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4213	017	1	1	09	04	H4213_017_1	6	Specialty Tier	3	010010	1	1	5	1		110	01	110		1				30		90	1	2	30		90				30		31											1.00	25		25				1.00	25		25				25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4213	017	2	1	09	04	H4213_017_2	6	Preferred Generic	3	001000	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								10.00		25.00					3.00		7.50					3.00		7.50																10.00				3.00			0.33	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4213	017	2	1	09	04	H4213_017_2	6	Generic	3	010000	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								20.00		50.00					13.00		32.50					13.00		32.50																20.00				13.00			0.67	0.43	0.43			0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4213	017	2	1	09	04	H4213_017_2	6	Preferred Brand	3	000001	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		117.50					42.00		105.00					42.00		105.00																47.00				42.00			1.57	1.40	1.40			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4213	017	2	1	09	04	H4213_017_2	6	Non-Preferred Brand	3	110000	1	2	4	1		110	01	110		1				30		90	1	2	30		90				30		31								100.00		250.00					95.00		237.50					95.00		237.50																100.00				95.00			3.33	3.17	3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4213	017	2	1	09	04	H4213_017_2	6	Specialty Tier	3	010010	1	1	5	1		110	01	110		1				30		90	1	2	30		90				30		31											1.00	25		25				1.00	25		25				25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4213	017	5	1	09	04	H4213_017_5	8	Preferred Generic	3	001000	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								10.00		25.00					3.00		7.50					3.00		7.50																10.00				3.00			0.33	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4213	017	5	1	09	04	H4213_017_5	8	Generic	3	010000	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								20.00		50.00					13.00		32.50					13.00		32.50																20.00				13.00			0.67	0.43	0.43			0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4213	017	5	1	09	04	H4213_017_5	8	Preferred Brand	3	000001	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		117.50					42.00		105.00					42.00		105.00																47.00				42.00			1.57	1.40	1.40			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4213	017	5	1	09	04	H4213_017_5	8	Non-Preferred Brand	3	110000	1	2	4	1		110	01	110		1				30		90	1	2	30		90				30		31								100.00		250.00					95.00		237.50					95.00		237.50																100.00				95.00			3.33	3.17	3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4213	017	5	1	09	04	H4213_017_5	8	Specialty Tier	3	010010	1	1	5	1		110	01	110		1				30		90	1	2	30		90				30		31											1.00	25		25				1.00	25		25				25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4213	017	6	1	09	04	H4213_017_6	6	Preferred Generic	3	001000	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								10.00		25.00					3.00		7.50					3.00		7.50																10.00				3.00			0.33	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4213	017	6	1	09	04	H4213_017_6	6	Generic	3	010000	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								20.00		50.00					13.00		32.50					13.00		32.50																20.00				13.00			0.67	0.43	0.43			0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4213	017	6	1	09	04	H4213_017_6	6	Preferred Brand	3	000001	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		117.50					42.00		105.00					42.00		105.00																47.00				42.00			1.57	1.40	1.40			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4213	017	6	1	09	04	H4213_017_6	6	Non-Preferred Brand	3	110000	1	2	4	1		110	01	110		1				30		90	1	2	30		90				30		31								100.00		250.00					95.00		237.50					95.00		237.50																100.00				95.00			3.33	3.17	3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4213	017	6	1	09	04	H4213_017_6	6	Specialty Tier	3	010010	1	1	5	1		110	01	110		1				30		90	1	2	30		90				30		31											1.00	25		25				1.00	25		25				25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4227	001	0	1	01	01	H4227_001_0	11	Preferred Generic	2	001000	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	6.00	12.00	18.00																					18.00																6.00				6.00		0.20						0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4227	001	0	1	01	01	H4227_001_0	11	Generic	2	010000	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	16.00	32.00	48.00																					48.00																16.00				16.00		0.53						0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4227	001	0	1	01	01	H4227_001_0	11	Preferred Brand	2	000001	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												
H4227	001	0	1	01	01	H4227_001_0	11	Non-Preferred Brand	2	100000	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												
H4227	001	0	1	01	01	H4227_001_0	11	Specialty Tier	2	010010	1	1	5	1	111		01	100		1	30	60	90				1	2			90				30		31					25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4227	002	0	1	01	01	H4227_002_0	10	Preferred Generic	2	001000	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	7.00	14.00	21.00																					21.00																7.00				7.00		0.23						0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4227	002	0	1	01	01	H4227_002_0	10	Generic	2	010000	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	17.00	34.00	51.00																					51.00																17.00				17.00		0.57						0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4227	002	0	1	01	01	H4227_002_0	10	Preferred Brand	2	000001	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												
H4227	002	0	1	01	01	H4227_002_0	10	Non-Preferred Brand	2	100000	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												
H4227	002	0	1	01	01	H4227_002_0	10	Specialty Tier	2	010010	1	1	5	1	111		01	100		1	30	60	90				1	2			90				30		31					25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4279	001	0	1	01	01	H4279_001_0	10	Preferred Generic	2	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	3.00		9.00																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4279	001	0	1	01	01	H4279_001_0	10	Preferred Brand	2	010001	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	30.00		90.00																					90.00																30.00				30.00		1.00						0.97	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4279	001	0	1	01	01	H4279_001_0	10	Non-Preferred Drug	2	110000	1	1	3	1	110		01	100		1	30		90				1	2			90				30		31				67.11	43		43																				43															43			43								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4279	001	0	1	01	01	H4279_001_0	10	Specialty Tier	2	010010	1	1	4	1	010		01	010		1	30								30						30		31				340.08	25																				25																	25			25								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4279	001	0	1	01	01	H4279_001_0	10	Select Care Drugs	2	010000	1	2	5	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	001	0	1	01	01	H4346_001_0	6	Preferred Generic	4	001000	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	001	0	1	01	01	H4346_001_0	6	Preferred Generic	4	001000	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4346	001	0	1	01	01	H4346_001_0	6	Generic	4	010000	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								12.50		37.50					7.50		22.50							18.75																12.50				12.50			0.42	0.25				0.40	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	001	0	1	01	01	H4346_001_0	6	Generic	4	010000	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								12.50		37.50					7.50		22.50							18.75																12.50				12.50			0.42	0.25				0.40	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4346	001	0	1	01	01	H4346_001_0	6	Preferred Brand	4	000001	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								45.00		135.00					40.00		120.00							100.00																45.00				45.00			1.50	1.33				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	001	0	1	01	01	H4346_001_0	6	Non-Preferred Drug	4	100100	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								95.00		285.00					85.00		255.00							212.50																95.00				95.00			3.17	2.83				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	001	0	1	01	01	H4346_001_0	6	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		31											538.00	33						538.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	001	0	1	01	01	H4346_001_0	6	Select Care Drugs	4	010010	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	001	0	1	01	01	H4346_001_0	6	Select Care Drugs	4	010010	1	2	6	3		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H4346	005	0	1	01	01	H4346_005_0	6	Preferred Generic	4	001000	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	005	0	1	01	01	H4346_005_0	6	Preferred Generic	4	001000	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4346	005	0	1	01	01	H4346_005_0	6	Generic	4	010000	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								12.50		37.50					7.50		22.50							18.75																12.50				12.50			0.42	0.25				0.40	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	005	0	1	01	01	H4346_005_0	6	Generic	4	010000	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								12.50		37.50					7.50		22.50							18.75																12.50				12.50			0.42	0.25				0.40	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4346	005	0	1	01	01	H4346_005_0	6	Preferred Brand	4	000001	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								45.00		135.00					40.00		120.00							100.00																45.00				45.00			1.50	1.33				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	005	0	1	01	01	H4346_005_0	6	Non-Preferred Drug	4	100100	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								95.00		285.00					85.00		255.00							212.50																95.00				95.00			3.17	2.83				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	005	0	1	01	01	H4346_005_0	6	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		31											538.00	33						538.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	005	0	1	01	01	H4346_005_0	6	Select Care Drugs	4	010010	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	005	0	1	01	01	H4346_005_0	6	Select Care Drugs	4	010010	1	2	6	3		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H4346	006	0	1	01	01	H4346_006_0	6	Preferred Generic	4	001000	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	006	0	1	01	01	H4346_006_0	6	Preferred Generic	4	001000	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4346	006	0	1	01	01	H4346_006_0	6	Generic	4	010000	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								12.50		37.50					7.50		22.50							18.75																12.50				12.50			0.42	0.25				0.40	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	006	0	1	01	01	H4346_006_0	6	Generic	4	010000	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								12.50		37.50					7.50		22.50							18.75																12.50				12.50			0.42	0.25				0.40	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4346	006	0	1	01	01	H4346_006_0	6	Preferred Brand	4	000001	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								45.00		135.00					40.00		120.00							100.00																45.00				45.00			1.50	1.33				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	006	0	1	01	01	H4346_006_0	6	Non-Preferred Drug	4	100100	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								95.00		285.00					85.00		255.00							212.50																95.00				95.00			3.17	2.83				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	006	0	1	01	01	H4346_006_0	6	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		31											538.00	33						538.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	006	0	1	01	01	H4346_006_0	6	Select Care Drugs	4	010010	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	006	0	1	01	01	H4346_006_0	6	Select Care Drugs	4	010010	1	2	6	3		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H4346	008	0	1	01	01	H4346_008_0	6	Preferred Generic	4	001000	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	008	0	1	01	01	H4346_008_0	6	Preferred Generic	4	001000	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4346	008	0	1	01	01	H4346_008_0	6	Generic	4	010000	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								12.50		37.50					7.50		22.50							18.75																12.50				12.50			0.42	0.25				0.40	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	008	0	1	01	01	H4346_008_0	6	Generic	4	010000	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								12.50		37.50					7.50		22.50							18.75																12.50				12.50			0.42	0.25				0.40	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4346	008	0	1	01	01	H4346_008_0	6	Preferred Brand	4	000001	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								45.00		135.00					40.00		120.00							100.00																45.00				45.00			1.50	1.33				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	008	0	1	01	01	H4346_008_0	6	Non-Preferred Drug	4	100100	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								95.00		285.00					85.00		255.00							212.50																95.00				95.00			3.17	2.83				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	008	0	1	01	01	H4346_008_0	6	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		31											538.00	33						538.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	008	0	1	01	01	H4346_008_0	6	Select Care Drugs	4	010010	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	008	0	1	01	01	H4346_008_0	6	Select Care Drugs	4	010010	1	2	6	3		110	01	100		1				30		90	1	2			90				30		31								0.00		0.00					0.00		0.00							0.00																0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H4346	009	0	1	01	01	H4346_009_0	7	Preferred Generic	4	001000	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								10.00		30.00					5.00		15.00							12.50																10.00				10.00			0.33	0.17				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	009	0	1	01	01	H4346_009_0	7	Generic	4	010000	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								15.50		46.50					10.50		31.50							26.25																15.50				15.50			0.52	0.35				0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	009	0	1	01	01	H4346_009_0	7	Preferred Brand	4	000001	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								45.00		135.00					40.00		120.00							100.00																45.00				45.00			1.50	1.33				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	009	0	1	01	01	H4346_009_0	7	Non-Preferred Drug	4	100100	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								95.00		285.00					90.00		270.00							225.00																95.00				95.00			3.17	3.00				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	009	0	1	01	01	H4346_009_0	7	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		31											538.00	33						538.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	009	0	1	01	01	H4346_009_0	7	Select Care Drugs	4	010010	1	2	6	1		110	01	100		1				30		90	1	2			90				30		31								10.00		30.00					10.00		30.00							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												
H4346	010	0	1	01	01	H4346_010_0	6	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	010	0	1	01	01	H4346_010_0	6	Preferred Generic	4	001000	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4346	010	0	1	01	01	H4346_010_0	6	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	7.50		22.50																					18.75																7.50				7.50		0.25						0.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	010	0	1	01	01	H4346_010_0	6	Generic	4	010000	1	2	2	3	110		01	100		1	30		90				1	2			90				30		31	7.50		22.50																					18.75																7.50				7.50		0.25						0.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4346	010	0	1	01	01	H4346_010_0	6	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	40.00		120.00																					100.00																40.00				40.00		1.33						1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	010	0	1	01	01	H4346_010_0	6	Non-Preferred Drug	4	100100	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	85.00		255.00																					212.50																85.00				85.00		2.83						2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	010	0	1	01	01	H4346_010_0	6	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31				538.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	010	0	1	01	01	H4346_010_0	6	Select Care Drugs	4	010010	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4346	010	0	1	01	01	H4346_010_0	6	Select Care Drugs	4	010010	1	2	6	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	2	
H4407	025	1	1	01	01	H4407_025_1	4	Preferred Generic	4	001000	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		31								6.00	12.00	6.00					1.00	2.00	1.00					6.00		6.00																6.00				6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4407	025	1	1	01	01	H4407_025_1	4	Generic	4	010000	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		31								14.00	28.00	14.00					8.00	16.00	8.00					14.00		14.00																14.00				14.00			0.47	0.27	0.47			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4407	025	1	1	01	01	H4407_025_1	4	Preferred Brand	4	000101	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					47.00		141.00																47.00				47.00			1.57	1.40	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4407	025	1	1	01	01	H4407_025_1	4	Non-Preferred Drug	4	100100	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		31								95.00	190.00	285.00					90.00	180.00	270.00					95.00		285.00																95.00				95.00			3.17	3.00	3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4407	025	1	1	01	01	H4407_025_1	4	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		31											454.93	27						305.06	27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4407	025	2	1	01	01	H4407_025_2	4	Preferred Generic	4	001000	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		31								6.00	12.00	6.00					1.00	2.00	1.00					6.00		6.00																6.00				6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4407	025	2	1	01	01	H4407_025_2	4	Generic	4	010000	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		31								14.00	28.00	14.00					8.00	16.00	8.00					14.00		14.00																14.00				14.00			0.47	0.27	0.47			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4407	025	2	1	01	01	H4407_025_2	4	Preferred Brand	4	000101	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					47.00		141.00																47.00				47.00			1.57	1.40	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4407	025	2	1	01	01	H4407_025_2	4	Non-Preferred Drug	4	100100	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		31								95.00	190.00	285.00					90.00	180.00	270.00					95.00		285.00																95.00				95.00			3.17	3.00	3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4407	025	2	1	01	01	H4407_025_2	4	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		31											454.93	27						305.06	27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4454	030	0	1	02	01	H4454_030_0	5	Preferred Generic	4	001000	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		31								8.00	16.00	20.00					3.00	6.00	7.50					8.00		20.00																8.00				8.00			0.27	0.10	0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4454	030	0	1	02	01	H4454_030_0	5	Preferred Generic	4	001000	1	2	1	3		111	01	110		1				30	60	90	1	2	30		90				30		31								8.00	16.00	20.00					3.00	6.00	7.50					8.00		20.00																8.00				8.00			0.27	0.10	0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4454	030	0	1	02	01	H4454_030_0	5	Generic	4	010000	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		31								17.00	34.00	42.50					12.00	24.00	30.00					17.00		42.50																17.00				17.00			0.57	0.40	0.57			0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4454	030	0	1	02	01	H4454_030_0	5	Preferred Brand	4	000101	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					47.00		141.00																47.00				47.00			1.57	1.40	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4454	030	0	1	02	01	H4454_030_0	5	Non-Preferred Drug	4	100100	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00		300.00																100.00				100.00			3.33	3.17	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4454	030	0	1	02	01	H4454_030_0	5	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		31											652.34	33						407.50	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4454	031	0	1	01	01	H4454_031_0	4	Preferred Generic	4	001000	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		31								8.00	16.00	16.00					3.00	6.00	6.00					8.00		16.00																8.00				8.00			0.27	0.10	0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4454	031	0	1	01	01	H4454_031_0	4	Preferred Generic	4	001000	1	2	1	3		111	01	110		1				30	60	90	1	2	30		90				30		31								8.00	16.00	16.00					3.00	6.00	6.00					8.00		16.00																8.00				8.00			0.27	0.10	0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4454	031	0	1	01	01	H4454_031_0	4	Generic	4	010000	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		31								17.00	34.00	34.00					12.00	24.00	24.00					17.00		34.00																17.00				17.00			0.57	0.40	0.57			0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4454	031	0	1	01	01	H4454_031_0	4	Preferred Brand	4	000101	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					47.00		141.00																47.00				47.00			1.57	1.40	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4454	031	0	1	01	01	H4454_031_0	4	Non-Preferred Drug	4	100100	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00		300.00																100.00				100.00			3.33	3.17	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4454	031	0	1	01	01	H4454_031_0	4	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		31											614.66	30						418.30	30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4454	033	0	1	01	01	H4454_033_0	4	Preferred Generic	4	001000	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		31								8.00	16.00	20.00					3.00	6.00	7.50					8.00		20.00																8.00				8.00			0.27	0.10	0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4454	033	0	1	01	01	H4454_033_0	4	Preferred Generic	4	001000	1	2	1	3		111	01	110		1				30	60	90	1	2	30		90				30		31								8.00	16.00	20.00					3.00	6.00	7.50					8.00		20.00																8.00				8.00			0.27	0.10	0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4454	033	0	1	01	01	H4454_033_0	4	Generic	4	010000	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		31								20.00	40.00	50.00					15.00	30.00	37.50					20.00		50.00																20.00				20.00			0.67	0.50	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4454	033	0	1	01	01	H4454_033_0	4	Preferred Brand	4	000101	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					47.00		141.00																47.00				47.00			1.57	1.40	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4454	033	0	1	01	01	H4454_033_0	4	Non-Preferred Drug	4	100100	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00		300.00																100.00				100.00			3.33	3.17	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4454	033	0	1	01	01	H4454_033_0	4	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		31											626.53	33						370.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4454	036	0	1	02	01	H4454_036_0	5	Preferred Generic	4	001000	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		31								5.00	10.00	12.50					0.00	0.00	0.00					5.00		12.50																5.00				5.00			0.17	0.00	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4454	036	0	1	02	01	H4454_036_0	5	Preferred Generic	4	001000	1	2	1	3		111	01	110		1				30	60	90	1	2	30		90				30		31								5.00	10.00	12.50					0.00	0.00	0.00					5.00		12.50																5.00				5.00			0.17	0.00	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4454	036	0	1	02	01	H4454_036_0	5	Generic	4	010000	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		31								12.00	24.00	30.00					7.00	14.00	17.50					12.00		30.00																12.00				12.00			0.40	0.23	0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4454	036	0	1	02	01	H4454_036_0	5	Preferred Brand	4	000101	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		31								47.00	94.00	117.50					42.00	84.00	105.00					47.00		117.50																47.00				47.00			1.57	1.40	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4454	036	0	1	02	01	H4454_036_0	5	Non-Preferred Drug	4	100100	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00		300.00																100.00				100.00			3.33	3.17	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4454	036	0	1	02	01	H4454_036_0	5	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		31											652.34	33						407.50	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4454	037	1	1	01	01	H4454_037_1	4	Preferred Generic	4	001000	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		31								8.00	16.00	20.00					3.00	6.00	7.50					8.00		20.00																8.00				8.00			0.27	0.10	0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4454	037	1	1	01	01	H4454_037_1	4	Preferred Generic	4	001000	1	2	1	3		111	01	110		1				30	60	90	1	2	30		90				30		31								8.00	16.00	20.00					3.00	6.00	7.50					8.00		20.00																8.00				8.00			0.27	0.10	0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4454	037	1	1	01	01	H4454_037_1	4	Generic	4	010000	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		31								17.00	34.00	42.50					12.00	24.00	30.00					17.00		42.50																17.00				17.00			0.57	0.40	0.57			0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4454	037	1	1	01	01	H4454_037_1	4	Preferred Brand	4	000101	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					47.00		141.00																47.00				47.00			1.57	1.40	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4454	037	1	1	01	01	H4454_037_1	4	Non-Preferred Drug	4	100100	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00		300.00																100.00				100.00			3.33	3.17	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4454	037	1	1	01	01	H4454_037_1	4	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		31											657.03	33						400.67	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4454	037	2	1	01	01	H4454_037_2	4	Preferred Generic	4	001000	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		31								8.00	16.00	20.00					3.00	6.00	7.50					8.00		20.00																8.00				8.00			0.27	0.10	0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4454	037	2	1	01	01	H4454_037_2	4	Preferred Generic	4	001000	1	2	1	3		111	01	110		1				30	60	90	1	2	30		90				30		31								8.00	16.00	20.00					3.00	6.00	7.50					8.00		20.00																8.00				8.00			0.27	0.10	0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4454	037	2	1	01	01	H4454_037_2	4	Generic	4	010000	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		31								17.00	34.00	42.50					12.00	24.00	30.00					17.00		42.50																17.00				17.00			0.57	0.40	0.57			0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4454	037	2	1	01	01	H4454_037_2	4	Preferred Brand	4	000101	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					47.00		141.00																47.00				47.00			1.57	1.40	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4454	037	2	1	01	01	H4454_037_2	4	Non-Preferred Drug	4	100100	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00		300.00																100.00				100.00			3.33	3.17	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4454	037	2	1	01	01	H4454_037_2	4	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		31											657.03	33						400.67	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	022	0	1	01	01	H4461_022_0	5	Preferred Generic	3	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	022	0	1	01	01	H4461_022_0	5	Generic	3	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								9.00		27.00					4.00		12.00											9.00		27.00				4.00		0.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	022	0	1	01	01	H4461_022_0	5	Preferred Brand	3	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	022	0	1	01	01	H4461_022_0	5	Non-Preferred Drug	3	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	022	0	1	01	01	H4461_022_0	5	Specialty Tier	3	010010	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	025	0	1	01	01	H4461_025_0	5	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	025	0	1	01	01	H4461_025_0	5	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H4461	025	0	1	01	01	H4461_025_0	5	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	025	0	1	01	01	H4461_025_0	5	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H4461	025	0	1	01	01	H4461_025_0	5	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	025	0	1	01	01	H4461_025_0	5	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H4461	025	0	1	01	01	H4461_025_0	5	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	025	0	1	01	01	H4461_025_0	5	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H4461	025	0	1	01	01	H4461_025_0	5	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	025	0	1	01	01	H4461_025_0	5	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H4461	029	0	1	01	01	H4461_029_0	5	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	029	0	1	01	01	H4461_029_0	5	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H4461	029	0	1	01	01	H4461_029_0	5	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	029	0	1	01	01	H4461_029_0	5	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H4461	029	0	1	01	01	H4461_029_0	5	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	029	0	1	01	01	H4461_029_0	5	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H4461	029	0	1	01	01	H4461_029_0	5	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	029	0	1	01	01	H4461_029_0	5	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H4461	029	0	1	01	01	H4461_029_0	5	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	029	0	1	01	01	H4461_029_0	5	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H4461	030	1	1	01	01	H4461_030_1	5	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	030	1	1	01	01	H4461_030_1	5	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H4461	030	1	1	01	01	H4461_030_1	5	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	030	1	1	01	01	H4461_030_1	5	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H4461	030	1	1	01	01	H4461_030_1	5	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	030	1	1	01	01	H4461_030_1	5	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H4461	030	1	1	01	01	H4461_030_1	5	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	030	1	1	01	01	H4461_030_1	5	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H4461	030	1	1	01	01	H4461_030_1	5	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	030	1	1	01	01	H4461_030_1	5	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H4461	030	2	1	01	01	H4461_030_2	5	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	030	2	1	01	01	H4461_030_2	5	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H4461	030	2	1	01	01	H4461_030_2	5	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	030	2	1	01	01	H4461_030_2	5	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H4461	030	2	1	01	01	H4461_030_2	5	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	030	2	1	01	01	H4461_030_2	5	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H4461	030	2	1	01	01	H4461_030_2	5	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	030	2	1	01	01	H4461_030_2	5	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H4461	030	2	1	01	01	H4461_030_2	5	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	030	2	1	01	01	H4461_030_2	5	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H4461	030	3	1	01	01	H4461_030_3	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	030	3	1	01	01	H4461_030_3	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H4461	030	3	1	01	01	H4461_030_3	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	030	3	1	01	01	H4461_030_3	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H4461	030	3	1	01	01	H4461_030_3	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	030	3	1	01	01	H4461_030_3	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H4461	030	3	1	01	01	H4461_030_3	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	030	3	1	01	01	H4461_030_3	4	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H4461	030	3	1	01	01	H4461_030_3	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	030	3	1	01	01	H4461_030_3	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H4461	031	1	1	01	01	H4461_031_1	5	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	031	1	1	01	01	H4461_031_1	5	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H4461	031	1	1	01	01	H4461_031_1	5	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	031	1	1	01	01	H4461_031_1	5	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H4461	031	1	1	01	01	H4461_031_1	5	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	031	1	1	01	01	H4461_031_1	5	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H4461	031	1	1	01	01	H4461_031_1	5	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	031	1	1	01	01	H4461_031_1	5	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H4461	031	1	1	01	01	H4461_031_1	5	Specialty Tier	4	010010	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												
H4461	031	1	1	01	01	H4461_031_1	5	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H4461	031	2	1	01	01	H4461_031_2	5	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	031	2	1	01	01	H4461_031_2	5	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H4461	031	2	1	01	01	H4461_031_2	5	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	031	2	1	01	01	H4461_031_2	5	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H4461	031	2	1	01	01	H4461_031_2	5	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	031	2	1	01	01	H4461_031_2	5	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H4461	031	2	1	01	01	H4461_031_2	5	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	031	2	1	01	01	H4461_031_2	5	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H4461	031	2	1	01	01	H4461_031_2	5	Specialty Tier	4	010010	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												
H4461	031	2	1	01	01	H4461_031_2	5	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H4461	031	3	1	01	01	H4461_031_3	5	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	031	3	1	01	01	H4461_031_3	5	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H4461	031	3	1	01	01	H4461_031_3	5	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	031	3	1	01	01	H4461_031_3	5	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H4461	031	3	1	01	01	H4461_031_3	5	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	031	3	1	01	01	H4461_031_3	5	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H4461	031	3	1	01	01	H4461_031_3	5	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4461	031	3	1	01	01	H4461_031_3	5	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H4461	031	3	1	01	01	H4461_031_3	5	Specialty Tier	4	010010	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												
H4461	031	3	1	01	01	H4461_031_3	5	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H4465	001	0	1	48	05	H4465_001_0	6	Generic Drugs	4	010000			1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		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			
H4465	001	0	1	48	05	H4465_001_0	6	Brand Drugs	4	000010			2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		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			
H4465	001	0	1	48	05	H4465_001_0	6	Non-Medicare Rx Drugs	4	010010			3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34																																														0.00			0.00			0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H4465	001	0	1	48	05	H4465_001_0	6	Non-Medicare OTC Drugs	4	010010			4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34																																														0.00			0.00			0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H4497	001	1	1	04	01	H4497_001_1	10	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	8.00	10.00																			5.00	8.00	10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	001	1	1	04	01	H4497_001_1	10	Preferred Generic	4	001000	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	8.00	10.00																			5.00	8.00	10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4497	001	1	1	04	01	H4497_001_1	10	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	19.00	29.00	38.00																			19.00	29.00	38.00																19.00				19.00		0.63			0.63			0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	001	1	1	04	01	H4497_001_1	10	Generic	4	010000	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	19.00	29.00	38.00																			19.00	29.00	38.00																19.00				19.00		0.63			0.63			0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4497	001	1	1	04	01	H4497_001_1	10	Preferred Brand	4	000001	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 Drug, Specialty Tier												
H4497	001	1	1	04	01	H4497_001_1	10	Non-Preferred Drug	4	110000	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				61.14	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	10	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31					29																				29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	001	2	1	04	01	H4497_001_2	10	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	8.00	10.00																			5.00	8.00	10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	001	2	1	04	01	H4497_001_2	10	Preferred Generic	4	001000	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	8.00	10.00																			5.00	8.00	10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4497	001	2	1	04	01	H4497_001_2	10	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	19.00	29.00	38.00																			19.00	29.00	38.00																19.00				19.00		0.63			0.63			0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	001	2	1	04	01	H4497_001_2	10	Generic	4	010000	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	19.00	29.00	38.00																			19.00	29.00	38.00																19.00				19.00		0.63			0.63			0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4497	001	2	1	04	01	H4497_001_2	10	Preferred Brand	4	000001	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 Drug, Specialty Tier												
H4497	001	2	1	04	01	H4497_001_2	10	Non-Preferred Drug	4	110000	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				61.14	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	10	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31					29																				29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	002	1	1	04	01	H4497_002_1	10	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	002	1	1	04	01	H4497_002_1	10	Preferred Generic	4	001000	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		
H4497	002	1	1	04	01	H4497_002_1	10	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	14.00	21.00	28.00																			14.00	21.00	28.00																14.00				14.00		0.47			0.47			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	002	1	1	04	01	H4497_002_1	10	Generic	4	010000	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	14.00	21.00	28.00																			14.00	21.00	28.00																14.00				14.00		0.47			0.47			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4497	002	1	1	04	01	H4497_002_1	10	Preferred Brand	4	000001	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	117.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	002	1	1	04	01	H4497_002_1	10	Non-Preferred Drug	4	110000	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				51.65	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	10	Specialty Tier	4	010010	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												
H4497	002	2	1	04	01	H4497_002_2	10	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	002	2	1	04	01	H4497_002_2	10	Preferred Generic	4	001000	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		
H4497	002	2	1	04	01	H4497_002_2	10	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	14.00	21.00	28.00																			14.00	21.00	28.00																14.00				14.00		0.47			0.47			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	002	2	1	04	01	H4497_002_2	10	Generic	4	010000	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	14.00	21.00	28.00																			14.00	21.00	28.00																14.00				14.00		0.47			0.47			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4497	002	2	1	04	01	H4497_002_2	10	Preferred Brand	4	000001	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	117.50																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	002	2	1	04	01	H4497_002_2	10	Non-Preferred Drug	4	110000	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				51.65	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	10	Specialty Tier	4	010010	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												
H4497	003	1	1	04	01	H4497_003_1	11	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	003	1	1	04	01	H4497_003_1	11	Preferred Generic	4	001000	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		
H4497	003	1	1	04	01	H4497_003_1	11	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	14.00	21.00	28.00																			14.00	21.00	28.00																14.00				14.00		0.47			0.47			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	003	1	1	04	01	H4497_003_1	11	Generic	4	010000	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	14.00	21.00	28.00																			14.00	21.00	28.00																14.00				14.00		0.47			0.47			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4497	003	1	1	04	01	H4497_003_1	11	Preferred Brand	4	000001	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 Drug, Specialty Tier												
H4497	003	1	1	04	01	H4497_003_1	11	Non-Preferred Drug	4	110000	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				51.32	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	11	Specialty Tier	4	010010	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												
H4497	003	2	1	04	01	H4497_003_2	11	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	003	2	1	04	01	H4497_003_2	11	Preferred Generic	4	001000	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		
H4497	003	2	1	04	01	H4497_003_2	11	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	14.00	21.00	28.00																			14.00	21.00	28.00																14.00				14.00		0.47			0.47			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4497	003	2	1	04	01	H4497_003_2	11	Generic	4	010000	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	14.00	21.00	28.00																			14.00	21.00	28.00																14.00				14.00		0.47			0.47			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4497	003	2	1	04	01	H4497_003_2	11	Preferred Brand	4	000001	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 Drug, Specialty Tier												
H4497	003	2	1	04	01	H4497_003_2	11	Non-Preferred Drug	4	110000	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				51.32	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	11	Specialty Tier	4	010010	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												
H4506	003	0	1	01	01	H4506_003_0	16	Preferred Generic	4	001001	1	2	1	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				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4506	003	0	1	01	01	H4506_003_0	16	Preferred Generic	4	001001	1	2	1	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				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4506	003	0	1	01	01	H4506_003_0	16	Generic	4	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		34	5.00		12.50																									5.00		12.50				5.00		5.00				5.00				5.00		0.17				0.17	0.17	0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4506	003	0	1	01	01	H4506_003_0	16	Generic	4	010001	1	2	2	3	110		01		110	1	30		90				1	2				30		90	30		34	5.00		12.50																									5.00		12.50				5.00		5.00				5.00				5.00		0.17				0.17	0.17	0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4506	003	0	1	01	01	H4506_003_0	16	Preferred Brand	4	000101	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		34	40.00		100.00																									40.00		100.00				40.00		80.00				40.00				40.00		1.33				1.33	1.33	1.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4506	003	0	1	01	01	H4506_003_0	16	Preferred Brand	4	000101	1	2	3	3	110		01		110	1	30		90				1	2				30		90	30		34	40.00		100.00																									40.00		100.00				40.00		80.00				40.00				40.00		1.33				1.33	1.33	1.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
H4506	003	0	1	01	01	H4506_003_0	16	Non-Preferred Drug	4	100100	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		34	80.00		200.00																									80.00		200.00				80.00		160.00				80.00				80.00		2.67				2.67	2.67	2.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4506	003	0	1	01	01	H4506_003_0	16	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		34				1.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4506	029	0	1	02	01	H4506_029_0	16	Preferred Generic	4	001001	1	2	1	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				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4506	029	0	1	02	01	H4506_029_0	16	Preferred Generic	4	001001	1	2	1	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				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4506	029	0	1	02	01	H4506_029_0	16	Generic	4	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		34	5.00		12.50																									5.00		12.50				5.00		5.00				5.00				5.00		0.17				0.17	0.17	0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4506	029	0	1	02	01	H4506_029_0	16	Preferred Brand	4	000101	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		34	40.00		100.00																									40.00		100.00				40.00		80.00				40.00				40.00		1.33				1.33	1.33	1.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4506	029	0	1	02	01	H4506_029_0	16	Non-Preferred Drug	4	100100	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		34	80.00		200.00																									80.00		200.00				80.00		160.00				80.00				80.00		2.67				2.67	2.67	2.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4506	029	0	1	02	01	H4506_029_0	16	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		34				1.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	025	0	1	01	01	H4513_025_0	4	Preferred Generic	4	001000	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		31								5.00	10.00	12.50					0.00	0.00	0.00					5.00		12.50																5.00				5.00			0.17	0.00	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	025	0	1	01	01	H4513_025_0	4	Preferred Generic	4	001000	1	2	1	3		111	01	110		1				30	60	90	1	2	30		90				30		31								5.00	10.00	12.50					0.00	0.00	0.00					5.00		12.50																5.00				5.00			0.17	0.00	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4513	025	0	1	01	01	H4513_025_0	4	Generic	4	010000	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		31								9.00	18.00	22.50					4.00	8.00	10.00					9.00		22.50																9.00				9.00			0.30	0.13	0.30			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	025	0	1	01	01	H4513_025_0	4	Preferred Brand	4	000101	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		31								45.00	90.00	135.00					40.00	80.00	120.00					45.00		135.00																45.00				45.00			1.50	1.33	1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	025	0	1	01	01	H4513_025_0	4	Non-Preferred Drug	4	100100	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		31								85.00	170.00	255.00					80.00	160.00	240.00					85.00		255.00																85.00				85.00			2.83	2.67	2.83			2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4513	025	0	1	01	01	H4513_025_0	4	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		31											655.62	33						451.73	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4514	007	0	1	01	01	H4514_007_0	5	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4514	007	0	1	01	01	H4514_007_0	5	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4514	007	0	1	01	01	H4514_007_0	5	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4514	007	0	1	01	01	H4514_007_0	5	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4514	007	0	1	01	01	H4514_007_0	5	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				870.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4523	001	0	1	01	01	H4523_001_0	5	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4523	001	0	1	01	01	H4523_001_0	5	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4523	001	0	1	01	01	H4523_001_0	5	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4523	001	0	1	01	01	H4523_001_0	5	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4523	001	0	1	01	01	H4523_001_0	5	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	5	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	5	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4523	015	0	1	01	01	H4523_015_0	4	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4523	015	0	1	01	01	H4523_015_0	4	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4523	015	0	1	01	01	H4523_015_0	4	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4523	015	0	1	01	01	H4523_015_0	4	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4523	015	0	1	01	01	H4523_015_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4523	020	0	1	01	01	H4523_020_0	3	Preferred Generic	4	001010	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4523	020	0	1	01	01	H4523_020_0	3	Preferred Generic	4	001010	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4523	020	0	1	01	01	H4523_020_0	3	Generic	4	010010	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4523	020	0	1	01	01	H4523_020_0	3	Generic	4	010010	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4523	020	0	1	01	01	H4523_020_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4523	020	0	1	01	01	H4523_020_0	3	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4523	020	0	1	01	01	H4523_020_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4523	021	0	1	01	01	H4523_021_0	3	Preferred Generic	4	001010	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4523	021	0	1	01	01	H4523_021_0	3	Preferred Generic	4	001010	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4523	021	0	1	01	01	H4523_021_0	3	Generic	4	010010	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4523	021	0	1	01	01	H4523_021_0	3	Generic	4	010010	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4523	021	0	1	01	01	H4523_021_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4523	021	0	1	01	01	H4523_021_0	3	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4523	021	0	1	01	01	H4523_021_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4523	024	0	1	01	01	H4523_024_0	3	Preferred Generic	4	001010	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4523	024	0	1	01	01	H4523_024_0	3	Preferred Generic	4	001010	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4523	024	0	1	01	01	H4523_024_0	3	Generic	4	010010	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4523	024	0	1	01	01	H4523_024_0	3	Generic	4	010010	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4523	024	0	1	01	01	H4523_024_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4523	024	0	1	01	01	H4523_024_0	3	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4523	024	0	1	01	01	H4523_024_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	001	0	1	01	01	H4527_001_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	001	0	1	01	01	H4527_001_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	001	0	1	01	01	H4527_001_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	001	0	1	01	01	H4527_001_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	001	0	1	01	01	H4527_001_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				940.00	26		26																										26						26			26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	002	0	1	01	01	H4527_002_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	002	0	1	01	01	H4527_002_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	002	0	1	01	01	H4527_002_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	002	0	1	01	01	H4527_002_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	002	0	1	01	01	H4527_002_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				1123.00	26		26																										26						26			26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	005	0	1	01	01	H4527_005_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	005	0	1	01	01	H4527_005_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	005	0	1	01	01	H4527_005_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	005	0	1	01	01	H4527_005_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	005	0	1	01	01	H4527_005_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				1014.00	26		26																										26						26			26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	013	0	1	01	01	H4527_013_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	013	0	1	01	01	H4527_013_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	013	0	1	01	01	H4527_013_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	013	0	1	01	01	H4527_013_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	013	0	1	01	01	H4527_013_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				918.00	26		26																										26						26			26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	037	0	1	01	01	H4527_037_0	5	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	037	0	1	01	01	H4527_037_0	5	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	037	0	1	01	01	H4527_037_0	5	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	037	0	1	01	01	H4527_037_0	5	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4527	037	0	1	01	01	H4527_037_0	5	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				903.00	32		32																										32						32			32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4528	001	0	1	01	01	H4528_001_0	5	Preferred Generic	4	001000	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		31								8.00	16.00	20.00					3.00	6.00	7.50					8.00		20.00																8.00				8.00			0.27	0.10	0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4528	001	0	1	01	01	H4528_001_0	5	Generic	4	010000	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		31								13.00	26.00	32.50					8.00	16.00	20.00					13.00		32.50																13.00				13.00			0.43	0.27	0.43			0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4528	001	0	1	01	01	H4528_001_0	5	Preferred Brand	4	000101	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		31								40.00	80.00	120.00					35.00	70.00	105.00					40.00		120.00																40.00				40.00			1.33	1.17	1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4528	001	0	1	01	01	H4528_001_0	5	Non-Preferred Drug	4	100100	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		31								75.00	150.00	225.00					70.00	140.00	210.00					75.00		225.00																75.00				75.00			2.50	2.33	2.50			2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4528	001	0	1	01	01	H4528_001_0	5	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		31											564.06	33						536.10	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4564	001	0	1	18	06	H4564_001_0	7	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4564	001	0	1	18	06	H4564_001_0	7	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	40.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4564	001	0	1	18	06	H4564_001_0	7	Preferred Brand	4	000001	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		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4564	001	0	1	18	06	H4564_001_0	7	Non-Preferred Drug	4	100100	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			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4564	001	0	1	18	06	H4564_001_0	7	Specialty Tier	4	010010	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												
H4564	002	0	1	18	06	H4564_002_0	8	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4564	002	0	1	18	06	H4564_002_0	8	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	40.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4564	002	0	1	18	06	H4564_002_0	8	Preferred Brand	4	000001	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		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4564	002	0	1	18	06	H4564_002_0	8	Non-Preferred Drug	4	100100	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			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4564	002	0	1	18	06	H4564_002_0	8	Specialty Tier	4	010010	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												
H4564	004	0	1	18	06	H4564_004_0	8	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4564	004	0	1	18	06	H4564_004_0	8	Preferred Generic	4	001000	1	2	1	3	111		01	111		1	30	60	90				2	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4564	004	0	1	18	06	H4564_004_0	8	Generic	4	010000	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			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4564	004	0	1	18	06	H4564_004_0	8	Preferred Brand	4	000001	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		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4564	004	0	1	18	06	H4564_004_0	8	Non-Preferred Drug	4	100100	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4564	004	0	1	18	06	H4564_004_0	8	Specialty Tier	4	010010	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												
H4564	005	0	1	18	06	H4564_005_0	8	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4564	005	0	1	18	06	H4564_005_0	8	Preferred Generic	4	001000	1	2	1	3	111		01	111		1	30	60	90				2	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4564	005	0	1	18	06	H4564_005_0	8	Generic	4	010000	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			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4564	005	0	1	18	06	H4564_005_0	8	Preferred Brand	4	000001	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		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4564	005	0	1	18	06	H4564_005_0	8	Non-Preferred Drug	4	100100	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4564	005	0	1	18	06	H4564_005_0	8	Specialty Tier	4	010010	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												
H4564	015	0	1	18	06	H4564_015_0	10	Preferred Generic	3	001000	1	2	1	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 Drug, Specialty Tier												
H4564	015	0	1	18	06	H4564_015_0	10	Generic	3	010000	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	40.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4564	015	0	1	18	06	H4564_015_0	10	Preferred Brand	3	000001	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 Drug, Specialty Tier												
H4564	015	0	1	18	06	H4564_015_0	10	Non-Preferred Drug	3	100100	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 Drug, Specialty Tier												
H4564	015	0	1	18	06	H4564_015_0	10	Specialty Tier	3	010010	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												
H4564	017	0	1	18	06	H4564_017_0	8	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4564	017	0	1	18	06	H4564_017_0	8	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	40.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4564	017	0	1	18	06	H4564_017_0	8	Preferred Brand	4	000001	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		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4564	017	0	1	18	06	H4564_017_0	8	Non-Preferred Drug	4	100100	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			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4564	017	0	1	18	06	H4564_017_0	8	Specialty Tier	4	010010	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												
H4564	018	0	1	18	06	H4564_018_0	8	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4564	018	0	1	18	06	H4564_018_0	8	Preferred Generic	4	001000	1	2	1	3	111		01	111		1	30	60	90				2	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4564	018	0	1	18	06	H4564_018_0	8	Generic	4	010000	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			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4564	018	0	1	18	06	H4564_018_0	8	Preferred Brand	4	000001	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		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4564	018	0	1	18	06	H4564_018_0	8	Non-Preferred Drug	4	100100	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4564	018	0	1	18	06	H4564_018_0	8	Specialty Tier	4	010010	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												
H4590	010	0	1	01	01	H4590_010_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	010	0	1	01	01	H4590_010_0	4	Preferred Generic	4	001000	1	2	1	3	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4590	010	0	1	01	01	H4590_010_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	010	0	1	01	01	H4590_010_0	4	Generic	4	010000	1	2	2	3	110		01		100	1	30		90				1	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4590	010	0	1	01	01	H4590_010_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						75.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	010	0	1	01	01	H4590_010_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	010	0	1	01	01	H4590_010_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				970.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	012	0	1	01	01	H4590_012_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	012	0	1	01	01	H4590_012_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	012	0	1	01	01	H4590_012_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	012	0	1	01	01	H4590_012_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	012	0	1	01	01	H4590_012_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				922.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	025	0	1	01	01	H4590_025_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	025	0	1	01	01	H4590_025_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	025	0	1	01	01	H4590_025_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	025	0	1	01	01	H4590_025_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	025	0	1	01	01	H4590_025_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				647.00	26		26																										26						26			26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	037	0	1	01	01	H4590_037_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	037	0	1	01	01	H4590_037_0	4	Preferred Generic	4	001000	1	2	1	3	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4590	037	0	1	01	01	H4590_037_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	037	0	1	01	01	H4590_037_0	4	Generic	4	010000	1	2	2	3	110		01		100	1	30		90				1	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H4590	037	0	1	01	01	H4590_037_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						75.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	037	0	1	01	01	H4590_037_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	037	0	1	01	01	H4590_037_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				1204.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	041	0	1	01	01	H4590_041_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	041	0	1	01	01	H4590_041_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	14.00		42.00																											42.00						0.00				14.00				14.00		0.46						0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	041	0	1	01	01	H4590_041_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	041	0	1	01	01	H4590_041_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4590	041	0	1	01	01	H4590_041_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				912.00	32		32																										32						32			32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	003	0	1	01	01	H4604_003_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	003	0	1	01	01	H4604_003_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	003	0	1	01	01	H4604_003_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	003	0	1	01	01	H4604_003_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	003	0	1	01	01	H4604_003_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				745.00	30		30																										30						30			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	011	0	1	01	01	H4604_011_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	011	0	1	01	01	H4604_011_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	011	0	1	01	01	H4604_011_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	011	0	1	01	01	H4604_011_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4604	011	0	1	01	01	H4604_011_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				676.00	30		30																										30						30			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4605	002	0	1	04	01	H4605_002_0	6	Preferred Generic	3	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	10.00																			5.00	10.00	10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4605	002	0	1	04	01	H4605_002_0	6	Generic	3	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	18.00	36.00	36.00																			18.00	36.00	36.00																18.00				18.00		0.60			0.60			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4605	002	0	1	04	01	H4605_002_0	6	Preferred Brand	3	000001	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, Select Care Drugs												
H4605	002	0	1	04	01	H4605_002_0	6	Non-Preferred Drug	3	100100	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				85.50	45	45	45																		45	45	45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4605	002	0	1	04	01	H4605_002_0	6	Specialty Tier	3	010010	1	1	5	1	010		01	010		1	30								30						30		31				1044.40	28																				28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4605	002	0	1	04	01	H4605_002_0	6	Select Care Drugs	3	010000	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4605	004	0	1	04	01	H4605_004_0	6	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	6.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4605	004	0	1	04	01	H4605_004_0	6	Generic	4	010000	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, Select Care Drugs												
H4605	004	0	1	04	01	H4605_004_0	6	Preferred Brand	4	000001	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, Select Care Drugs												
H4605	004	0	1	04	01	H4605_004_0	6	Non-Preferred Drug	4	100100	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				76.00	40	40	40																		40	40	40															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4605	004	0	1	04	01	H4605_004_0	6	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31				1230.90	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4605	004	0	1	04	01	H4605_004_0	6	Select Care Drugs	4	010000	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																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	7	Preferred Generic	4	001000	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											7.00	14.00	21.00				2.00	4.00	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, Select Care Drugs												
H4754	004	0	1	04	01	H4754_004_0	7	Generic	4	010000	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	36.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4754	004	0	1	04	01	H4754_004_0	7	Preferred Brand	4	000001	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4754	004	0	1	04	01	H4754_004_0	7	Preferred Brand	4	000001	1	2	3	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2		
H4754	004	0	1	04	01	H4754_004_0	7	Non-Preferred Drug	4	100100	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	270.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4754	004	0	1	04	01	H4754_004_0	7	Non-Preferred Drug	4	100100	1	2	4	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	270.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H4754	004	0	1	04	01	H4754_004_0	7	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4754	004	0	1	04	01	H4754_004_0	7	Select Care Drugs	4	010000	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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	7	Select Care Drugs	4	010000	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4754	007	0	1	04	01	H4754_007_0	6	Preferred Generic	4	001000	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											7.00	14.00	21.00				2.00	4.00	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, Select Care Drugs												
H4754	007	0	1	04	01	H4754_007_0	6	Generic	4	010000	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	36.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4754	007	0	1	04	01	H4754_007_0	6	Preferred Brand	4	000001	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4754	007	0	1	04	01	H4754_007_0	6	Preferred Brand	4	000001	1	2	3	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2		
H4754	007	0	1	04	01	H4754_007_0	6	Non-Preferred Drug	4	100100	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	270.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4754	007	0	1	04	01	H4754_007_0	6	Non-Preferred Drug	4	100100	1	2	4	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	270.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H4754	007	0	1	04	01	H4754_007_0	6	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4754	007	0	1	04	01	H4754_007_0	6	Select Care Drugs	4	010000	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4754	007	0	1	04	01	H4754_007_0	6	Select Care Drugs	4	010000	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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	6	Preferred Generic	4	001000	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											7.00	14.00	21.00				2.00	4.00	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, Select Care Drugs												
H4754	009	0	1	04	01	H4754_009_0	6	Generic	4	010000	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	36.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4754	009	0	1	04	01	H4754_009_0	6	Preferred Brand	4	000001	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4754	009	0	1	04	01	H4754_009_0	6	Preferred Brand	4	000001	1	2	3	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2		
H4754	009	0	1	04	01	H4754_009_0	6	Non-Preferred Drug	4	100100	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	270.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4754	009	0	1	04	01	H4754_009_0	6	Non-Preferred Drug	4	100100	1	2	4	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	270.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H4754	009	0	1	04	01	H4754_009_0	6	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4754	009	0	1	04	01	H4754_009_0	6	Select Care Drugs	4	010000	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			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	6	Select Care Drugs	4	010000	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4754	011	0	1	04	01	H4754_011_0	6	Preferred Generic	4	001000	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											7.00	14.00	21.00				2.00	4.00	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, Select Care Drugs												
H4754	011	0	1	04	01	H4754_011_0	6	Generic	4	010000	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	36.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4754	011	0	1	04	01	H4754_011_0	6	Preferred Brand	4	000001	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4754	011	0	1	04	01	H4754_011_0	6	Preferred Brand	4	000001	1	2	3	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	111.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2		
H4754	011	0	1	04	01	H4754_011_0	6	Non-Preferred Drug	4	100100	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	270.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4754	011	0	1	04	01	H4754_011_0	6	Non-Preferred Drug	4	100100	1	2	4	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	270.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H4754	011	0	1	04	01	H4754_011_0	6	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4754	011	0	1	04	01	H4754_011_0	6	Select Care Drugs	4	010000	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4754	011	0	1	04	01	H4754_011_0	6	Select Care Drugs	4	010000	1	2	6	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H4875	016	1	1	04	01	H4875_016_1	9	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	0.00																7.00				7.00			0.23	0.07	0.07			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	016	1	1	04	01	H4875_016_1	9	Generic	4	010010	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					10.00	20.00	30.00					10.00	20.00	0.00																15.00				15.00			0.50	0.33	0.33			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	016	1	1	04	01	H4875_016_1	9	Preferred Brand	4	000001	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	105.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	016	1	1	04	01	H4875_016_1	9	Non-Preferred Drug	4	110000	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												
H4875	016	1	1	04	01	H4875_016_1	9	Specialty Tier	4	010010	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												
H4875	016	2	1	04	01	H4875_016_2	9	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	0.00																7.00				7.00			0.23	0.07	0.07			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	016	2	1	04	01	H4875_016_2	9	Generic	4	010010	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					10.00	20.00	30.00					10.00	20.00	0.00																15.00				15.00			0.50	0.33	0.33			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	016	2	1	04	01	H4875_016_2	9	Preferred Brand	4	000001	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	105.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	016	2	1	04	01	H4875_016_2	9	Non-Preferred Drug	4	110000	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												
H4875	016	2	1	04	01	H4875_016_2	9	Specialty Tier	4	010010	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												
H4875	016	3	1	04	01	H4875_016_3	9	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	0.00																7.00				7.00			0.23	0.07	0.07			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	016	3	1	04	01	H4875_016_3	9	Generic	4	010010	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					10.00	20.00	30.00					10.00	20.00	0.00																15.00				15.00			0.50	0.33	0.33			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	016	3	1	04	01	H4875_016_3	9	Preferred Brand	4	000001	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	105.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	016	3	1	04	01	H4875_016_3	9	Non-Preferred Drug	4	110000	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												
H4875	016	3	1	04	01	H4875_016_3	9	Specialty Tier	4	010010	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												
H4875	016	4	1	04	01	H4875_016_4	9	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	0.00																7.00				7.00			0.23	0.07	0.07			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	016	4	1	04	01	H4875_016_4	9	Generic	4	010010	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					10.00	20.00	30.00					10.00	20.00	0.00																15.00				15.00			0.50	0.33	0.33			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	016	4	1	04	01	H4875_016_4	9	Preferred Brand	4	000001	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	105.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	016	4	1	04	01	H4875_016_4	9	Non-Preferred Drug	4	110000	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												
H4875	016	4	1	04	01	H4875_016_4	9	Specialty Tier	4	010010	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												
H4875	016	5	1	04	01	H4875_016_5	9	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					2.00	4.00	6.00					2.00	4.00	0.00																7.00				7.00			0.23	0.07	0.07			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	016	5	1	04	01	H4875_016_5	9	Generic	4	010010	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					10.00	20.00	30.00					10.00	20.00	0.00																15.00				15.00			0.50	0.33	0.33			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	016	5	1	04	01	H4875_016_5	9	Preferred Brand	4	000001	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	105.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	016	5	1	04	01	H4875_016_5	9	Non-Preferred Drug	4	110000	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												
H4875	016	5	1	04	01	H4875_016_5	9	Specialty Tier	4	010010	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												
H4875	017	1	1	04	01	H4875_017_1	9	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	0.00																6.00				6.00			0.20	0.03	0.03			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	017	1	1	04	01	H4875_017_1	9	Generic	4	010010	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	36.00					7.00	14.00	21.00					7.00	14.00	0.00																12.00				12.00			0.40	0.23	0.23			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	017	1	1	04	01	H4875_017_1	9	Preferred Brand	4	000001	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								42.00	84.00	126.00					37.00	74.00	111.00					37.00	74.00	92.50																42.00				42.00			1.40	1.23	1.23			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	017	1	1	04	01	H4875_017_1	9	Non-Preferred Drug	4	110000	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								85.00	170.00	255.00					80.00	160.00	240.00					80.00	160.00	200.00																85.00				85.00			2.83	2.67	2.67			2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	017	1	1	04	01	H4875_017_1	9	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	017	2	1	04	01	H4875_017_2	9	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	0.00																6.00				6.00			0.20	0.03	0.03			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	017	2	1	04	01	H4875_017_2	9	Generic	4	010010	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	36.00					7.00	14.00	21.00					7.00	14.00	0.00																12.00				12.00			0.40	0.23	0.23			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	017	2	1	04	01	H4875_017_2	9	Preferred Brand	4	000001	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								42.00	84.00	126.00					37.00	74.00	111.00					37.00	74.00	92.50																42.00				42.00			1.40	1.23	1.23			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	017	2	1	04	01	H4875_017_2	9	Non-Preferred Drug	4	110000	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								85.00	170.00	255.00					80.00	160.00	240.00					80.00	160.00	200.00																85.00				85.00			2.83	2.67	2.67			2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	017	2	1	04	01	H4875_017_2	9	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	017	3	1	04	01	H4875_017_3	9	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	0.00																6.00				6.00			0.20	0.03	0.03			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	017	3	1	04	01	H4875_017_3	9	Generic	4	010010	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	36.00					7.00	14.00	21.00					7.00	14.00	0.00																12.00				12.00			0.40	0.23	0.23			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	017	3	1	04	01	H4875_017_3	9	Preferred Brand	4	000001	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								42.00	84.00	126.00					37.00	74.00	111.00					37.00	74.00	92.50																42.00				42.00			1.40	1.23	1.23			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	017	3	1	04	01	H4875_017_3	9	Non-Preferred Drug	4	110000	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								85.00	170.00	255.00					80.00	160.00	240.00					80.00	160.00	200.00																85.00				85.00			2.83	2.67	2.67			2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	017	3	1	04	01	H4875_017_3	9	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	017	4	1	04	01	H4875_017_4	9	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	0.00																6.00				6.00			0.20	0.03	0.03			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	017	4	1	04	01	H4875_017_4	9	Generic	4	010010	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	36.00					7.00	14.00	21.00					7.00	14.00	0.00																12.00				12.00			0.40	0.23	0.23			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	017	4	1	04	01	H4875_017_4	9	Preferred Brand	4	000001	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								42.00	84.00	126.00					37.00	74.00	111.00					37.00	74.00	92.50																42.00				42.00			1.40	1.23	1.23			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	017	4	1	04	01	H4875_017_4	9	Non-Preferred Drug	4	110000	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								85.00	170.00	255.00					80.00	160.00	240.00					80.00	160.00	200.00																85.00				85.00			2.83	2.67	2.67			2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	017	4	1	04	01	H4875_017_4	9	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	017	5	1	04	01	H4875_017_5	9	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								6.00	12.00	18.00					1.00	2.00	3.00					1.00	2.00	0.00																6.00				6.00			0.20	0.03	0.03			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	017	5	1	04	01	H4875_017_5	9	Generic	4	010010	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	36.00					7.00	14.00	21.00					7.00	14.00	0.00																12.00				12.00			0.40	0.23	0.23			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	017	5	1	04	01	H4875_017_5	9	Preferred Brand	4	000001	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								42.00	84.00	126.00					37.00	74.00	111.00					37.00	74.00	92.50																42.00				42.00			1.40	1.23	1.23			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	017	5	1	04	01	H4875_017_5	9	Non-Preferred Drug	4	110000	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								85.00	170.00	255.00					80.00	160.00	240.00					80.00	160.00	200.00																85.00				85.00			2.83	2.67	2.67			2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4875	017	5	1	04	01	H4875_017_5	9	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H4876	001	0	1	04	01	H4876_001_0	13	Generic	4	010000	1	2	1	1	111		01	100		1	30	60	90				2	1			90				30		31	5.00	10.00	15.00																					15.00																5.00				5.00		0.17						0.16	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4876	001	0	1	04	01	H4876_001_0	13	Generic	4	010000	1	2	1	3	111		01	100		1	30	60	90				2	1			90				30		31	5.00	10.00	15.00																					15.00																5.00				5.00		0.17						0.16	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H4876	001	0	1	04	01	H4876_001_0	13	Preferred Brand	4	000001	1	2	2	1	111		01	100		1	30	60	90				2	1			90				30		31	25.00	50.00	75.00																					75.00																25.00				25.00		0.83						0.81	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4876	001	0	1	04	01	H4876_001_0	13	Non-Preferred Brand	4	100000	3	2	3	1	111		01	100		1	30	60	90				2	1			90				30		31	45.00	90.00	135.00																					135.00																45.00				45.00		1.50						1.45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4876	001	0	1	04	01	H4876_001_0	13	Specialty Tier	4	010010	1	1	4	1	111		01	100		1	30	60	90				2	1			90				30		31				1540.11	33	33	33																				33															33			33								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4909	014	0	1	04	01	H4909_014_0	7	Preferred Generic	4	001000	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												
H4909	014	0	1	04	01	H4909_014_0	7	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4909	014	0	1	04	01	H4909_014_0	7	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	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												
H4909	014	0	1	04	01	H4909_014_0	7	Non-Preferred Drug	4	100100	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												
H4909	014	0	1	04	01	H4909_014_0	7	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		34												30							30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H4909	014	0	1	04	01	H4909_014_0	7	Select Care Drugs	4	001000	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			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	7	Select Care Drugs	4	001000	1	2	6	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		
H4922	005	1	1	01	01	H4922_005_1	6	Preferred Generic	3	001000	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	5.00	10.00	15.00																					12.50																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4922	005	1	1	01	01	H4922_005_1	6	Generic	3	010000	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	20.00	40.00	60.00																					50.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4922	005	1	1	01	01	H4922_005_1	6	Preferred Brand	3	000001	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4922	005	1	1	01	01	H4922_005_1	6	Non-Preferred Brand	3	100000	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				100.00	50	50	50																				50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4922	005	1	1	01	01	H4922_005_1	6	Specialty Tier	3	010010	1	1	5	1	111		01	100		1	30	60	90				1	2			90				30		31				100.00	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4922	005	2	1	01	01	H4922_005_2	5	Preferred Generic	3	001000	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	5.00	10.00	15.00																					12.50																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4922	005	2	1	01	01	H4922_005_2	5	Generic	3	010000	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	20.00	40.00	60.00																					50.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4922	005	2	1	01	01	H4922_005_2	5	Preferred Brand	3	000001	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4922	005	2	1	01	01	H4922_005_2	5	Non-Preferred Brand	3	100000	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				100.00	50	50	50																				50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H4922	005	2	1	01	01	H4922_005_2	5	Specialty Tier	3	010010	1	1	5	1	111		01	100		1	30	60	90				1	2			90				30		31				100.00	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5009	002	0	1	04	01	H5009_002_0	8	Preferred Generic	3	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	10.00																			5.00	10.00	10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5009	002	0	1	04	01	H5009_002_0	8	Generic	3	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	20.00	40.00	40.00																			20.00	40.00	40.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5009	002	0	1	04	01	H5009_002_0	8	Preferred Brand	3	000001	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, Select Care Drugs												
H5009	002	0	1	04	01	H5009_002_0	8	Non-Preferred Drug	3	100100	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				85.50	45	45	45																		45	45	45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5009	002	0	1	04	01	H5009_002_0	8	Specialty Tier	3	010010	1	1	5	1	010		01	010		1	30								30						30		31				1044.40	28																				28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5009	002	0	1	04	01	H5009_002_0	8	Select Care Drugs	3	010000	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5010	002	0	1	04	01	H5010_002_0	8	Preferred Generic	3	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	10.00																			5.00	10.00	10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5010	002	0	1	04	01	H5010_002_0	8	Generic	3	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	17.00	34.00	34.00																			17.00	34.00	34.00																17.00				17.00		0.57			0.57			0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5010	002	0	1	04	01	H5010_002_0	8	Preferred Brand	3	000001	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, Select Care Drugs												
H5010	002	0	1	04	01	H5010_002_0	8	Non-Preferred Drug	3	100100	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				83.60	44	44	44																		44	44	44															44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5010	002	0	1	04	01	H5010_002_0	8	Specialty Tier	3	010010	1	1	5	1	010		01	010		1	30								30						30		31				1044.40	28																				28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5010	002	0	1	04	01	H5010_002_0	8	Select Care Drugs	3	010000	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5010	004	0	1	04	01	H5010_004_0	8	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	6.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5010	004	0	1	04	01	H5010_004_0	8	Generic	4	010000	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, Select Care Drugs												
H5010	004	0	1	04	01	H5010_004_0	8	Preferred Brand	4	000001	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, Select Care Drugs												
H5010	004	0	1	04	01	H5010_004_0	8	Non-Preferred Drug	4	100100	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				76.00	40	40	40																		40	40	40															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5010	004	0	1	04	01	H5010_004_0	8	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31				1230.90	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5010	004	0	1	04	01	H5010_004_0	8	Select Care Drugs	4	010000	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5050	004	0	1	01	01	H5050_004_0	7	Preferred Generic	4	001000	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		0.11			0.11			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	004	0	1	01	01	H5050_004_0	7	Generic	4	010000	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		0.35			0.35			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	004	0	1	01	01	H5050_004_0	7	Preferred Brand	4	000001	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		1.44			1.44			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	004	0	1	01	01	H5050_004_0	7	Non-Preferred Brand	4	100000	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		2.22			2.22			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	004	0	1	01	01	H5050_004_0	7	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31				1019.93	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	009	0	1	01	01	H5050_009_0	8	Preferred Generic	4	001000	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		0.11			0.11			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	009	0	1	01	01	H5050_009_0	8	Generic	4	010000	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		0.37			0.37			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	009	0	1	01	01	H5050_009_0	8	Preferred Brand	4	000001	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		1.44			1.44			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	009	0	1	01	01	H5050_009_0	8	Non-Preferred Brand	4	100000	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		2.35			2.35			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	009	0	1	01	01	H5050_009_0	8	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31				1232.66	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	013	0	1	01	01	H5050_013_0	8	Preferred Generic	4	001000	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		0.11			0.11			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	013	0	1	01	01	H5050_013_0	8	Generic	4	010000	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		0.34			0.34			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	013	0	1	01	01	H5050_013_0	8	Preferred Brand	4	000001	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		1.46			1.46			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	013	0	1	01	01	H5050_013_0	8	Non-Preferred Brand	4	100000	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		2.26			2.26			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	013	0	1	01	01	H5050_013_0	8	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31				1150.64	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	017	0	1	01	01	H5050_017_0	7	Preferred Generic	4	001000	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		0.13			0.13			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	017	0	1	01	01	H5050_017_0	7	Generic	4	010000	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		0.39			0.39			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	017	0	1	01	01	H5050_017_0	7	Preferred Brand	4	000001	1	2	3	1	111		01	111		1	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		1.54			1.54			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	017	0	1	01	01	H5050_017_0	7	Non-Preferred Brand	4	100000	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				97.00		2.85			2.85			3.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	017	0	1	01	01	H5050_017_0	7	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31				1459.27	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	019	0	1	01	01	H5050_019_0	8	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	9.00																3.00				3.00		0.09			0.09			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	019	0	1	01	01	H5050_019_0	8	Generic	4	010000	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		0.19			0.19			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	019	0	1	01	01	H5050_019_0	8	Preferred Brand	4	000001	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		1.28			1.28			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	019	0	1	01	01	H5050_019_0	8	Non-Preferred Brand	4	100000	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				90.00		2.31			2.31			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	019	0	1	01	01	H5050_019_0	8	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31				1687.21	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	021	0	1	01	01	H5050_021_0	8	Preferred Generic	4	001000	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		0.15			0.15			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	021	0	1	01	01	H5050_021_0	8	Generic	4	010000	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		0.31			0.31			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	021	0	1	01	01	H5050_021_0	8	Preferred Brand	4	000001	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		1.47			1.47			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	021	0	1	01	01	H5050_021_0	8	Non-Preferred Brand	4	100000	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		2.51			2.51			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5050	021	0	1	01	01	H5050_021_0	8	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31				1400.30	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5087	001	0	1	01	01	H5087_001_0	6	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5087	001	0	1	01	01	H5087_001_0	6	Generic	4	010001	3	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		50.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5087	001	0	1	01	01	H5087_001_0	6	Preferred Brand	4	000101	1	2	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												
H5087	001	0	1	01	01	H5087_001_0	6	Non-Preferred Drug	4	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				91.17	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5087	001	0	1	01	01	H5087_001_0	6	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				2292.71	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5087	002	0	1	01	01	H5087_002_0	6	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5087	002	0	1	01	01	H5087_002_0	6	Generic	4	010001	3	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		50.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5087	002	0	1	01	01	H5087_002_0	6	Preferred Brand	4	000101	1	2	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												
H5087	002	0	1	01	01	H5087_002_0	6	Non-Preferred Drug	4	100100	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		247.50				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5087	002	0	1	01	01	H5087_002_0	6	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				1905.97	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5087	005	0	1	01	01	H5087_005_0	6	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5087	005	0	1	01	01	H5087_005_0	6	Preferred Generic	4	001001	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		
H5087	005	0	1	01	01	H5087_005_0	6	Generic	4	010001	3	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		37.50				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5087	005	0	1	01	01	H5087_005_0	6	Preferred Brand	4	000101	1	2	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												
H5087	005	0	1	01	01	H5087_005_0	6	Non-Preferred Drug	4	100100	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		247.50				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5087	005	0	1	01	01	H5087_005_0	6	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				2506.73	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5087	016	0	1	01	01	H5087_016_0	6	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5087	016	0	1	01	01	H5087_016_0	6	Preferred Generic	4	001001	1	2	1	3	110		01		110	1	30		90				1	2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		0.00				7.00				7.00		0.23				0.23	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5087	016	0	1	01	01	H5087_016_0	6	Generic	4	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		37.50				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5087	016	0	1	01	01	H5087_016_0	6	Preferred Brand	4	000101	1	2	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												
H5087	016	0	1	01	01	H5087_016_0	6	Non-Preferred Drug	4	100100	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		247.50				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5087	016	0	1	01	01	H5087_016_0	6	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				2366.35	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5087	017	0	1	01	01	H5087_017_0	6	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5087	017	0	1	01	01	H5087_017_0	6	Generic	4	010001	3	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		50.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5087	017	0	1	01	01	H5087_017_0	6	Preferred Brand	4	000101	1	2	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												
H5087	017	0	1	01	01	H5087_017_0	6	Non-Preferred Drug	4	100100	1	2	4	1	110		01		110	1	30		90				1	2				30		90	30		31	99.00		297.00																									99.00		297.00				99.00		247.50				99.00				99.00		3.30				3.30	3.30	3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5087	017	0	1	01	01	H5087_017_0	6	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				1994.37	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5106	013	0	1	04	01	H5106_013_0	7	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	31		90				1	2			90				31		31	3.00		9.00																					7.50																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5106	013	0	1	04	01	H5106_013_0	7	Generic	4	010000	1	2	2	1	110		01	100		1	31		90				1	2			90				31		31	20.00		60.00																					50.00																20.00				20.00		0.65						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5106	013	0	1	04	01	H5106_013_0	7	Preferred Brand	4	010001	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												
H5106	013	0	1	04	01	H5106_013_0	7	Non-Preferred Drug	4	110000	1	1	4	1	110		01	100		1	31		90				1	2			90				31		31				91.97	45		45																				45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5106	013	0	1	04	01	H5106_013_0	7	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	31								31						31		31				924.38	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	001	0	1	04	01	H5141_001_0	7	Preferred Generic	4	001000	1	2	1	1		111	01	100		1				30	60	100	1	2			100				30		31								5.00	10.00	15.00					0.00	0.00	0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	001	0	1	04	01	H5141_001_0	7	Generic	4	010000	1	2	2	1		111	01	100		1				30	60	100	1	2			100				30		31								15.00	30.00	45.00					10.00	20.00	30.00							20.00																15.00				15.00			0.50	0.33				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	001	0	1	04	01	H5141_001_0	7	Preferred Brand	4	000101	1	2	3	1		111	01	100		1				30	60	100	1	2			100				30		31								45.00	90.00	135.00					35.00	70.00	105.00							70.00																45.00				45.00			1.50	1.17				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	001	0	1	04	01	H5141_001_0	7	Non-Preferred Drug	4	100100	1	2	4	1		111	01	100		1				30	60	100	1	2			100				30		31								95.00	190.00	285.00					85.00	170.00	255.00							170.00																95.00				95.00			3.17	2.83				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	001	0	1	04	01	H5141_001_0	7	Specialty Tier	4	010010	1	1	5	1		111	01	100		1				30	60	100	1	2			100				30		31											400.00	25	25	25				400.00	25	25	25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	004	0	1	04	01	H5141_004_0	8	Preferred Generic	4	001000	1	2	1	1		111	01	100		1				30	60	100	1	2			100				30		31								5.00	10.00	15.00					0.00	0.00	0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	004	0	1	04	01	H5141_004_0	8	Generic	4	010000	1	2	2	1		111	01	100		1				30	60	100	1	2			100				30		31								15.00	30.00	45.00					10.00	20.00	30.00							20.00																15.00				15.00			0.50	0.33				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	004	0	1	04	01	H5141_004_0	8	Preferred Brand	4	000101	1	2	3	1		111	01	100		1				30	60	100	1	2			100				30		31								45.00	90.00	135.00					35.00	70.00	105.00							70.00																45.00				45.00			1.50	1.17				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	004	0	1	04	01	H5141_004_0	8	Non-Preferred Drug	4	100100	1	2	4	1		111	01	100		1				30	60	100	1	2			100				30		31								95.00	190.00	285.00					85.00	170.00	255.00							170.00																95.00				95.00			3.17	2.83				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	004	0	1	04	01	H5141_004_0	8	Specialty Tier	4	010010	1	1	5	1		111	01	100		1				30	60	100	1	2			100				30		31											400.00	25	25	25				400.00	25	25	25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	006	0	1	04	01	H5141_006_0	7	Preferred Generic	4	001000	1	2	1	1		111	01	100		1				30	60	100	1	2			100				30		31								5.00	10.00	15.00					0.00	0.00	0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	006	0	1	04	01	H5141_006_0	7	Preferred Generic	4	001000	1	2	1	3		111	01	100		1				30	60	100	1	2			100				30		31								5.00	10.00	15.00					0.00	0.00	0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5141	006	0	1	04	01	H5141_006_0	7	Generic	4	010000	1	2	2	1		111	01	100		1				30	60	100	1	2			100				30		31								12.00	24.00	36.00					7.00	14.00	21.00							14.00																12.00				12.00			0.40	0.23				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	006	0	1	04	01	H5141_006_0	7	Generic	4	010000	1	2	2	3		111	01	100		1				30	60	100	1	2			100				30		31								12.00	24.00	36.00					7.00	14.00	21.00							14.00																12.00				12.00			0.40	0.23				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5141	006	0	1	04	01	H5141_006_0	7	Preferred Brand	4	000001	1	2	3	1		111	01	100		1				30	60	100	1	2			100				30		31								47.00	94.00	141.00					37.00	74.00	111.00							74.00																47.00				47.00			1.57	1.23				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	006	0	1	04	01	H5141_006_0	7	Non-Preferred Drug	4	100000	1	2	4	1		111	01	100		1				30	60	100	1	2			100				30		31								90.00	180.00	270.00					80.00	160.00	240.00							160.00																90.00				90.00			3.00	2.67				2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	006	0	1	04	01	H5141_006_0	7	Specialty Tier	4	010010	1	1	5	1		111	01	100		1				30	60	100	1	2			100				30		31											400.00	25	25	25				400.00	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	9	Preferred Generic	3	001000	1	2	1	1		111	01	100		1				30	60	100	1	2			100				30		31								5.00	10.00	15.00					0.00	0.00	0.00							0.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	007	0	1	04	01	H5141_007_0	9	Generic	3	010000	1	2	2	1		111	01	100		1				30	60	100	1	2			100				30		31								12.00	24.00	36.00					7.00	14.00	21.00							14.00																12.00				12.00			0.40	0.23				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	007	0	1	04	01	H5141_007_0	9	Preferred Brand	3	000001	1	2	3	1		111	01	100		1				30	60	100	1	2			100				30		31								40.00	80.00	120.00					30.00	60.00	90.00							60.00																40.00				40.00			1.33	1.00				1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	007	0	1	04	01	H5141_007_0	9	Non-Preferred Drug	3	100000	1	2	4	1		111	01	100		1				30	60	100	1	2			100				30		31								90.00	180.00	270.00					80.00	160.00	240.00							160.00																90.00				90.00			3.00	2.67				2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5141	007	0	1	04	01	H5141_007_0	9	Specialty Tier	3	010010	1	1	5	1		111	01	100		1				30	60	100	1	2			100				30		31											400.00	25	25	25				400.00	25	25	25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5172	002	0	1	48	05	H5172_002_0	12	Generic Drugs	4	010000			1	1	110		01	110		1	31		93				1	2	31		93				31		31																																														0.00			0.00			0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H5172	002	0	1	48	05	H5172_002_0	12	Brand Drugs	4	000010			2	1	110		01	110		1	31		93				1	2	31		93				31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	0.00	8.25	0.00	8.25	0.00	8.25	0.00	8.25			
H5172	002	0	1	48	05	H5172_002_0	12	Non-Medicare Rx Drugs	4	010010			3	1	110		01	110		1	31		93				1	2	31		93				31		31																																														0.00			0.00			0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H5172	002	0	1	48	05	H5172_002_0	12	Non-Medicare OTC Drugs	4	010010			4	1	110		01	110		1	31		93				1	2	31		93				31		31																																														0.00			0.00			0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H5190	001	0	1	01	01	H5190_001_0	12	Preferred Generic	3	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5190	001	0	1	01	01	H5190_001_0	12	Generic	3	010000	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		.60			0.60			.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5190	001	0	1	01	01	H5190_001_0	12	Preferred Brand	3	000001	1	2	3	1	111		01	111		1	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												
H5190	001	0	1	01	01	H5190_001_0	12	Non-Preferred Brand	3	100000	1	2	4	1	111		01	111		1	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												
H5190	001	0	1	01	01	H5190_001_0	12	Specialty Tier	3	010010	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												
H5190	002	0	1	01	01	H5190_002_0	9	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5190	002	0	1	01	01	H5190_002_0	9	Generic	4	010000	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 Brand, Specialty Tier												
H5190	002	0	1	01	01	H5190_002_0	9	Preferred Brand	4	000001	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	46.00	92.00	138.00																			46.00	92.00	138.00																46.00				46.00		1.53			1.53			1.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5190	002	0	1	01	01	H5190_002_0	9	Non-Preferred Brand	4	100000	1	2	4	1	111		01	111		1	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												
H5190	002	0	1	01	01	H5190_002_0	9	Specialty Tier	4	010010	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												
H5190	003	0	1	01	01	H5190_003_0	8	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5190	003	0	1	01	01	H5190_003_0	8	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	19.00	38.00	57.00																			19.00	38.00	57.00																19.00				19.00		0.63			0.63			0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5190	003	0	1	01	01	H5190_003_0	8	Preferred Brand	4	000001	1	2	3	1	111		01	111		1	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												
H5190	003	0	1	01	01	H5190_003_0	8	Non-Preferred Brand	4	100000	1	2	4	1	111		01	111		1	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												
H5190	003	0	1	01	01	H5190_003_0	8	Specialty Tier	4	010010	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												
H5190	004	0	1	01	01	H5190_004_0	8	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5190	004	0	1	01	01	H5190_004_0	8	Preferred Generic	4	001000	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5190	004	0	1	01	01	H5190_004_0	8	Generic	4	010000	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 Brand, Specialty Tier												
H5190	004	0	1	01	01	H5190_004_0	8	Preferred Brand	4	000001	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	44.00	88.00	132.00																			44.00	88.00	132.00																44.00				44.00		1.47			1.47			1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5190	004	0	1	01	01	H5190_004_0	8	Non-Preferred Brand	4	100000	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				90.00		3.00			3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5190	004	0	1	01	01	H5190_004_0	8	Specialty Tier	4	010010	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												
H5211	002	0	1	02	01	H5211_002_0	14	Preferred Generic	3	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	6.00	12.00	18.00																			6.00	12.00	18.00																6.00				6.00		0.20			0.20			0.17	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	002	0	1	02	01	H5211_002_0	14	Generic	3	010000	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				20.00		0.66			0.66			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	002	0	1	02	01	H5211_002_0	14	Preferred Brand	3	000101	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.50			1.50			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	002	0	1	02	01	H5211_002_0	14	Non-Preferred Drug	3	100100	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	002	0	1	02	01	H5211_002_0	14	Specialty Tier	3	010010	1	1	5	1	010		01	010		1	30								30						30		34				1329.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	002	0	1	02	01	H5211_002_0	14	Vaccines	3	010010	1	2	6	1	010		01			1	30														30		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	11	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	9.00	18.00	27.00																			9.00	18.00	27.00																9.00				9.00		0.30			0.30			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	004	0	1	02	01	H5211_004_0	11	Generic	4	010000	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				20.00		0.66			0.66			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	004	0	1	02	01	H5211_004_0	11	Preferred Brand	4	000101	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				47.00		1.56			1.56			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	004	0	1	02	01	H5211_004_0	11	Non-Preferred Drug	4	100100	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	004	0	1	02	01	H5211_004_0	11	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		34				1573.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	004	0	1	02	01	H5211_004_0	11	Vaccines	4	010010	1	2	6	1	010		01			1	30														30		34	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	007	0	1	02	01	H5211_007_0	10	Preferred Generic	3	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	2.00	4.00	6.00																			2.00	4.00	6.00																2.00				2.00		0.06			0.06			0.05	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	007	0	1	02	01	H5211_007_0	10	Generic	3	010000	1	2	2	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				10.00		0.33			0.33			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	007	0	1	02	01	H5211_007_0	10	Preferred Brand	3	000101	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	43.00	86.00	129.00																			43.00	86.00	129.00																43.00				43.00		1.43			1.43			1.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	007	0	1	02	01	H5211_007_0	10	Non-Preferred Drug	3	100100	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	007	0	1	02	01	H5211_007_0	10	Specialty Tier	3	010010	1	1	5	1	010		01	010		1	30								30						30		34				1382.00	26																				26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	007	0	1	02	01	H5211_007_0	10	Vaccines	3	010010	1	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 Drug, Specialty Tier, Vaccines												
H5211	008	0	1	02	01	H5211_008_0	12	Preferred Generic	3	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	2.00	4.00	6.00																			2.00	4.00	6.00																2.00				2.00		0.06			0.06			0.05	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	008	0	1	02	01	H5211_008_0	12	Generic	3	010000	1	2	2	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				10.00		0.33			0.33			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	008	0	1	02	01	H5211_008_0	12	Preferred Brand	3	000101	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	43.00	86.00	129.00																			43.00	86.00	129.00																43.00				43.00		1.43			1.43			1.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	008	0	1	02	01	H5211_008_0	12	Non-Preferred Drug	3	100100	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	008	0	1	02	01	H5211_008_0	12	Specialty Tier	3	010010	1	1	5	1	010		01	010		1	30								30						30		34				1382.00	26																				26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	008	0	1	02	01	H5211_008_0	12	Vaccines	3	010010	1	2	6	1	010		01			1	30														30		34	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	009	0	1	02	01	H5211_009_0	11	Preferred Generic	3	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	6.00	12.00	18.00																			6.00	12.00	18.00																6.00				6.00		0.20			0.20			0.17	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	009	0	1	02	01	H5211_009_0	11	Generic	3	010000	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				20.00		0.66			0.66			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	009	0	1	02	01	H5211_009_0	11	Preferred Brand	3	000101	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.50			1.50			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	009	0	1	02	01	H5211_009_0	11	Non-Preferred Drug	3	100100	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	009	0	1	02	01	H5211_009_0	11	Specialty Tier	3	010010	1	1	5	1	010		01	010		1	30								30						30		34				1329.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H5211	009	0	1	02	01	H5211_009_0	11	Vaccines	3	010010	1	2	6	1	010		01			1	30														30		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	7	Preferred Generic	4	001000	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								4.00		10.00					2.00		5.00					2.00		5.00																2.00				2.00			0.13	0.07	0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	002	0	1	04	01	H5215_002_0	7	Generic	4	010000	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								13.00		33.00					8.00		20.00					8.00		20.00																8.00				8.00			0.43	0.27	0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	002	0	1	04	01	H5215_002_0	7	Preferred Brand	4	000101	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		118.00					44.00		110.00					44.00		110.00																44.00				44.00			1.57	1.47	1.47			1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	002	0	1	04	01	H5215_002_0	7	Non-Preferred Brand	4	100100	1	2	4	1		110	01	110		1				30		90	1	2	30		90				30		31								90.00		225.00					85.00		213.00					85.00		213.00																85.00				85.00			3.00	2.83	2.83			2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	002	0	1	04	01	H5215_002_0	7	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		31												27							27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	005	0	1	04	01	H5215_005_0	8	Preferred Generic	4	001000	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								4.00		10.00					2.00		5.00					2.00		5.00																2.00				2.00			0.13	0.07	0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	005	0	1	04	01	H5215_005_0	8	Generic	4	010000	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								13.00		33.00					8.00		20.00					8.00		20.00																8.00				8.00			0.43	0.27	0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	005	0	1	04	01	H5215_005_0	8	Preferred Brand	4	000101	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		118.00					44.00		110.00					44.00		110.00																44.00				44.00			1.57	1.47	1.47			1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	005	0	1	04	01	H5215_005_0	8	Non-Preferred Brand	4	100100	1	2	4	1		110	01	110		1				30		90	1	2	30		90				30		31								90.00		225.00					85.00		213.00					85.00		213.00																85.00				85.00			3.00	2.83	2.83			2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	005	0	1	04	01	H5215_005_0	8	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		31												27							27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	007	0	1	04	01	H5215_007_0	11	Preferred Generic	3	001000	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								3.00		8.00					1.00		3.00					1.00		3.00																1.00				1.00			0.10	0.03	0.03			0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	007	0	1	04	01	H5215_007_0	11	Generic	3	010000	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								18.00		35.00					13.00		30.00					13.00		30.00																13.00				13.00			0.60	0.43	0.43			0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	007	0	1	04	01	H5215_007_0	11	Preferred Brand	3	000101	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								45.00		130.00					42.00		120.00					42.00		120.00																42.00				42.00			1.50	1.40	1.40			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	007	0	1	04	01	H5215_007_0	11	Non-Preferred Brand	3	100100	1	2	4	1		110	01	110		1				30		90	1	2	30		90				30		31								86.00		225.00					80.00		212.00					80.00		212.00																80.00				80.00			2.87	2.67	2.67			2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	007	0	1	04	01	H5215_007_0	11	Specialty Tier	3	010010	1	1	5	1		010	01	010		1				30					30						30		31												29							29						29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	008	0	1	04	01	H5215_008_0	7	Preferred Generic	4	001000	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								4.00		10.00					2.00		5.00					2.00		5.00																2.00				2.00			0.13	0.07	0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	008	0	1	04	01	H5215_008_0	7	Generic	4	010000	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								13.00		33.00					8.00		20.00					8.00		20.00																8.00				8.00			0.43	0.27	0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	008	0	1	04	01	H5215_008_0	7	Preferred Brand	4	000101	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		118.00					44.00		110.00					44.00		110.00																44.00				44.00			1.57	1.47	1.47			1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	008	0	1	04	01	H5215_008_0	7	Non-Preferred Brand	4	100100	1	2	4	1		110	01	110		1				30		90	1	2	30		90				30		31								90.00		225.00					85.00		213.00					85.00		213.00																85.00				85.00			3.00	2.83	2.83			2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	008	0	1	04	01	H5215_008_0	7	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		31												27							27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	009	0	1	04	01	H5215_009_0	7	Preferred Generic	4	001000	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								4.00		10.00					2.00		5.00					2.00		5.00																2.00				2.00			0.13	0.07	0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	009	0	1	04	01	H5215_009_0	7	Generic	4	010000	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								13.00		33.00					8.00		20.00					8.00		20.00																8.00				8.00			0.43	0.27	0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	009	0	1	04	01	H5215_009_0	7	Preferred Brand	4	000101	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		118.00					44.00		110.00					44.00		110.00																44.00				44.00			1.57	1.47	1.47			1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	009	0	1	04	01	H5215_009_0	7	Non-Preferred Brand	4	100100	1	2	4	1		110	01	110		1				30		90	1	2	30		90				30		31								90.00		225.00					85.00		213.00					85.00		213.00																85.00				85.00			3.00	2.83	2.83			2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	009	0	1	04	01	H5215_009_0	7	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		31												27							27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	010	0	1	04	01	H5215_010_0	7	Preferred Generic	4	001000	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								4.00		10.00					2.00		5.00					2.00		5.00																2.00				2.00			0.13	0.07	0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	010	0	1	04	01	H5215_010_0	7	Generic	4	010000	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								13.00		33.00					8.00		20.00					8.00		20.00																8.00				8.00			0.43	0.27	0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	010	0	1	04	01	H5215_010_0	7	Preferred Brand	4	000101	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		118.00					44.00		110.00					44.00		110.00																44.00				44.00			1.57	1.47	1.47			1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	010	0	1	04	01	H5215_010_0	7	Non-Preferred Brand	4	100100	1	2	4	1		110	01	110		1				30		90	1	2	30		90				30		31								90.00		225.00					85.00		213.00					85.00		213.00																85.00				85.00			3.00	2.83	2.83			2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5215	010	0	1	04	01	H5215_010_0	7	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		31												27							27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5216	001	0	1	04	01	H5216_001_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	001	0	1	04	01	H5216_001_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5216	001	0	1	04	01	H5216_001_0	3	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	001	0	1	04	01	H5216_001_0	3	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5216	001	0	1	04	01	H5216_001_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	001	0	1	04	01	H5216_001_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5216	001	0	1	04	01	H5216_001_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	001	0	1	04	01	H5216_001_0	3	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5216	001	0	1	04	01	H5216_001_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	001	0	1	04	01	H5216_001_0	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5216	006	0	1	04	01	H5216_006_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	006	0	1	04	01	H5216_006_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5216	006	0	1	04	01	H5216_006_0	3	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	006	0	1	04	01	H5216_006_0	3	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5216	006	0	1	04	01	H5216_006_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	006	0	1	04	01	H5216_006_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5216	006	0	1	04	01	H5216_006_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	006	0	1	04	01	H5216_006_0	3	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5216	006	0	1	04	01	H5216_006_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	006	0	1	04	01	H5216_006_0	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5216	009	0	1	04	01	H5216_009_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	009	0	1	04	01	H5216_009_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5216	009	0	1	04	01	H5216_009_0	3	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	009	0	1	04	01	H5216_009_0	3	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5216	009	0	1	04	01	H5216_009_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	009	0	1	04	01	H5216_009_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5216	009	0	1	04	01	H5216_009_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	009	0	1	04	01	H5216_009_0	3	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5216	009	0	1	04	01	H5216_009_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	009	0	1	04	01	H5216_009_0	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5216	011	0	1	04	01	H5216_011_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	011	0	1	04	01	H5216_011_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5216	011	0	1	04	01	H5216_011_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	011	0	1	04	01	H5216_011_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5216	011	0	1	04	01	H5216_011_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	011	0	1	04	01	H5216_011_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5216	011	0	1	04	01	H5216_011_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	011	0	1	04	01	H5216_011_0	4	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5216	011	0	1	04	01	H5216_011_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	011	0	1	04	01	H5216_011_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5216	013	0	1	04	01	H5216_013_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	013	0	1	04	01	H5216_013_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5216	013	0	1	04	01	H5216_013_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	013	0	1	04	01	H5216_013_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5216	013	0	1	04	01	H5216_013_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	013	0	1	04	01	H5216_013_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5216	013	0	1	04	01	H5216_013_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	013	0	1	04	01	H5216_013_0	4	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5216	013	0	1	04	01	H5216_013_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	013	0	1	04	01	H5216_013_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5216	014	0	1	04	01	H5216_014_0	3	Preferred Generic	4	001010	1	2	1	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												
H5216	014	0	1	04	01	H5216_014_0	3	Preferred Generic	4	001010	1	2	1	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										2	3	
H5216	014	0	1	04	01	H5216_014_0	3	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					18.00		54.00											20.00		60.00				18.00		0.00				20.00				20.00			0.67	0.60		0.67	0.60	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	014	0	1	04	01	H5216_014_0	3	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					18.00		54.00											20.00		60.00				18.00		0.00				20.00				20.00			0.67	0.60		0.67	0.60	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5216	014	0	1	04	01	H5216_014_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	014	0	1	04	01	H5216_014_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5216	014	0	1	04	01	H5216_014_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	014	0	1	04	01	H5216_014_0	3	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5216	014	0	1	04	01	H5216_014_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5216	014	0	1	04	01	H5216_014_0	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5253	004	0	1	01	01	H5253_004_0	5	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	004	0	1	01	01	H5253_004_0	5	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	9.00		27.00																											27.00						0.00				9.00				9.00		0.30						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	004	0	1	01	01	H5253_004_0	5	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		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	004	0	1	01	01	H5253_004_0	5	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	004	0	1	01	01	H5253_004_0	5	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				673.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	011	0	1	01	01	H5253_011_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	011	0	1	01	01	H5253_011_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	11.00		33.00																											33.00						0.00				11.00				11.00		0.36						0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	011	0	1	01	01	H5253_011_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	011	0	1	01	01	H5253_011_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	011	0	1	01	01	H5253_011_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				607.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	030	0	1	01	01	H5253_030_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	030	0	1	01	01	H5253_030_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		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	030	0	1	01	01	H5253_030_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		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	030	0	1	01	01	H5253_030_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	030	0	1	01	01	H5253_030_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				594.00	27		27																										27						27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	033	0	1	01	01	H5253_033_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	033	0	1	01	01	H5253_033_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		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	01	01	H5253_033_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	033	0	1	01	01	H5253_033_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	033	0	1	01	01	H5253_033_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				671.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	034	0	1	01	01	H5253_034_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	034	0	1	01	01	H5253_034_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		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	034	0	1	01	01	H5253_034_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	034	0	1	01	01	H5253_034_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	034	0	1	01	01	H5253_034_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				580.00	26		26																										26						26			26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	035	0	1	02	01	H5253_035_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	035	0	1	02	01	H5253_035_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	035	0	1	02	01	H5253_035_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		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	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		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	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				844.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	036	0	1	01	01	H5253_036_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	036	0	1	01	01	H5253_036_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	036	0	1	01	01	H5253_036_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	036	0	1	01	01	H5253_036_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	036	0	1	01	01	H5253_036_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				641.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	037	0	1	01	01	H5253_037_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	037	0	1	01	01	H5253_037_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	037	0	1	01	01	H5253_037_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	037	0	1	01	01	H5253_037_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	037	0	1	01	01	H5253_037_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				969.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	038	0	1	01	01	H5253_038_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	038	0	1	01	01	H5253_038_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	038	0	1	01	01	H5253_038_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	038	0	1	01	01	H5253_038_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	038	0	1	01	01	H5253_038_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				846.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	039	0	1	01	01	H5253_039_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	039	0	1	01	01	H5253_039_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	039	0	1	01	01	H5253_039_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	039	0	1	01	01	H5253_039_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	039	0	1	01	01	H5253_039_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				877.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	043	0	1	02	01	H5253_043_0	7	Preferred Generic	3	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	043	0	1	02	01	H5253_043_0	7	Generic	3	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		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	7	Preferred Brand	3	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		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	7	Non-Preferred Drug	3	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		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	7	Specialty Tier	3	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				785.00	31		31																										31						31			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	044	0	1	01	01	H5253_044_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	044	0	1	01	01	H5253_044_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	044	0	1	01	01	H5253_044_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		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	044	0	1	01	01	H5253_044_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		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	044	0	1	01	01	H5253_044_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				635.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	045	0	1	01	01	H5253_045_0	4	Preferred Generic	3	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	045	0	1	01	01	H5253_045_0	4	Generic	3	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	045	0	1	01	01	H5253_045_0	4	Preferred Brand	3	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		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	045	0	1	01	01	H5253_045_0	4	Non-Preferred Drug	3	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		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	045	0	1	01	01	H5253_045_0	4	Specialty Tier	3	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				587.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	046	0	1	01	01	H5253_046_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	046	0	1	01	01	H5253_046_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	046	0	1	01	01	H5253_046_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		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	046	0	1	01	01	H5253_046_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	046	0	1	01	01	H5253_046_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				514.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	047	0	1	02	01	H5253_047_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	047	0	1	02	01	H5253_047_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	047	0	1	02	01	H5253_047_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		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	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		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	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				731.00	31		31																										31						31			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	048	0	1	02	01	H5253_048_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	048	0	1	02	01	H5253_048_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	048	0	1	02	01	H5253_048_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		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	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		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	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				814.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	049	0	1	01	01	H5253_049_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	049	0	1	01	01	H5253_049_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	049	0	1	01	01	H5253_049_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	049	0	1	01	01	H5253_049_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	049	0	1	01	01	H5253_049_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				727.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	050	0	1	01	01	H5253_050_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	050	0	1	01	01	H5253_050_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	050	0	1	01	01	H5253_050_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	050	0	1	01	01	H5253_050_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	050	0	1	01	01	H5253_050_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				747.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	051	0	1	01	01	H5253_051_0	4	Preferred Generic	4	001000	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	051	0	1	01	01	H5253_051_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	051	0	1	01	01	H5253_051_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	051	0	1	01	01	H5253_051_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	051	0	1	01	01	H5253_051_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				776.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	052	0	1	01	01	H5253_052_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	052	0	1	01	01	H5253_052_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	052	0	1	01	01	H5253_052_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	052	0	1	01	01	H5253_052_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	052	0	1	01	01	H5253_052_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				611.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	053	0	1	01	01	H5253_053_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	053	0	1	01	01	H5253_053_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	053	0	1	01	01	H5253_053_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	053	0	1	01	01	H5253_053_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	053	0	1	01	01	H5253_053_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				738.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	054	0	1	01	01	H5253_054_0	4	Preferred Generic	4	001000	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	054	0	1	01	01	H5253_054_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	054	0	1	01	01	H5253_054_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	054	0	1	01	01	H5253_054_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	054	0	1	01	01	H5253_054_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				827.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	055	0	1	01	01	H5253_055_0	4	Preferred Generic	4	001000	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	055	0	1	01	01	H5253_055_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	055	0	1	01	01	H5253_055_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		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	055	0	1	01	01	H5253_055_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		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	055	0	1	01	01	H5253_055_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				783.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	056	0	1	01	01	H5253_056_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	056	0	1	01	01	H5253_056_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	056	0	1	01	01	H5253_056_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	056	0	1	01	01	H5253_056_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	056	0	1	01	01	H5253_056_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				747.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	057	0	1	01	01	H5253_057_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	057	0	1	01	01	H5253_057_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	057	0	1	01	01	H5253_057_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	057	0	1	01	01	H5253_057_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	057	0	1	01	01	H5253_057_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				726.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	061	0	1	02	01	H5253_061_0	7	Preferred Generic	3	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	061	0	1	02	01	H5253_061_0	7	Generic	3	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		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	7	Preferred Brand	3	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		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	7	Non-Preferred Drug	3	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		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	7	Specialty Tier	3	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				766.00	30		30																										30						30			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	062	0	1	01	01	H5253_062_0	5	Preferred Generic	3	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	062	0	1	01	01	H5253_062_0	5	Generic	3	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	062	0	1	01	01	H5253_062_0	5	Preferred Brand	3	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		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	062	0	1	01	01	H5253_062_0	5	Non-Preferred Drug	3	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		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	062	0	1	01	01	H5253_062_0	5	Specialty Tier	3	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				718.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	063	0	1	01	01	H5253_063_0	5	Preferred Generic	4	001000	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	063	0	1	01	01	H5253_063_0	5	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	063	0	1	01	01	H5253_063_0	5	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	063	0	1	01	01	H5253_063_0	5	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	063	0	1	01	01	H5253_063_0	5	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				826.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	064	0	1	02	01	H5253_064_0	7	Preferred Generic	3	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	064	0	1	02	01	H5253_064_0	7	Generic	3	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		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	7	Preferred Brand	3	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		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	7	Non-Preferred Drug	3	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		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	7	Specialty Tier	3	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				873.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	067	0	1	01	01	H5253_067_0	5	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	067	0	1	01	01	H5253_067_0	5	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	067	0	1	01	01	H5253_067_0	5	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	067	0	1	01	01	H5253_067_0	5	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	067	0	1	01	01	H5253_067_0	5	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				864.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	068	0	1	01	01	H5253_068_0	5	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	068	0	1	01	01	H5253_068_0	5	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	068	0	1	01	01	H5253_068_0	5	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	068	0	1	01	01	H5253_068_0	5	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	068	0	1	01	01	H5253_068_0	5	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				802.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	072	0	1	01	01	H5253_072_0	5	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	072	0	1	01	01	H5253_072_0	5	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		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	072	0	1	01	01	H5253_072_0	5	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	072	0	1	01	01	H5253_072_0	5	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	072	0	1	01	01	H5253_072_0	5	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				581.00	26		26																										26						26			26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	073	0	1	01	01	H5253_073_0	5	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	073	0	1	01	01	H5253_073_0	5	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	11.00		33.00																											33.00						0.00				11.00				11.00		0.36						0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	073	0	1	01	01	H5253_073_0	5	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		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	073	0	1	01	01	H5253_073_0	5	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	073	0	1	01	01	H5253_073_0	5	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				607.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	074	0	1	01	01	H5253_074_0	5	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	074	0	1	01	01	H5253_074_0	5	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	074	0	1	01	01	H5253_074_0	5	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	074	0	1	01	01	H5253_074_0	5	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	074	0	1	01	01	H5253_074_0	5	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				633.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	075	0	1	01	01	H5253_075_0	5	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	075	0	1	01	01	H5253_075_0	5	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	075	0	1	01	01	H5253_075_0	5	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		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	075	0	1	01	01	H5253_075_0	5	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	075	0	1	01	01	H5253_075_0	5	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				752.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	076	0	1	01	01	H5253_076_0	5	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	076	0	1	01	01	H5253_076_0	5	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	076	0	1	01	01	H5253_076_0	5	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	076	0	1	01	01	H5253_076_0	5	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	076	0	1	01	01	H5253_076_0	5	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				633.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	077	0	1	01	01	H5253_077_0	5	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	077	0	1	01	01	H5253_077_0	5	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	077	0	1	01	01	H5253_077_0	5	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		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	077	0	1	01	01	H5253_077_0	5	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	077	0	1	01	01	H5253_077_0	5	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				697.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	078	0	1	02	01	H5253_078_0	5	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	078	0	1	02	01	H5253_078_0	5	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	078	0	1	02	01	H5253_078_0	5	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		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	078	0	1	02	01	H5253_078_0	5	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		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	078	0	1	02	01	H5253_078_0	5	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				751.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	079	0	1	01	01	H5253_079_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	079	0	1	01	01	H5253_079_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	079	0	1	01	01	H5253_079_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	079	0	1	01	01	H5253_079_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	079	0	1	01	01	H5253_079_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				843.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	080	0	1	01	01	H5253_080_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	080	0	1	01	01	H5253_080_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	080	0	1	01	01	H5253_080_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	080	0	1	01	01	H5253_080_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	080	0	1	01	01	H5253_080_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				969.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	081	0	1	01	01	H5253_081_0	4	Preferred Generic	3	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	081	0	1	01	01	H5253_081_0	4	Generic	3	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	081	0	1	01	01	H5253_081_0	4	Preferred Brand	3	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	081	0	1	01	01	H5253_081_0	4	Non-Preferred Drug	3	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	081	0	1	01	01	H5253_081_0	4	Specialty Tier	3	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				713.00	30		30																										30						30			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	082	0	1	01	01	H5253_082_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	082	0	1	01	01	H5253_082_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	082	0	1	01	01	H5253_082_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	082	0	1	01	01	H5253_082_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	082	0	1	01	01	H5253_082_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				773.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	083	0	1	01	01	H5253_083_0	4	Preferred Generic	3	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	083	0	1	01	01	H5253_083_0	4	Generic	3	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	083	0	1	01	01	H5253_083_0	4	Preferred Brand	3	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	083	0	1	01	01	H5253_083_0	4	Non-Preferred Drug	3	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	083	0	1	01	01	H5253_083_0	4	Specialty Tier	3	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				713.00	30		30																										30						30			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	084	0	1	01	01	H5253_084_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	084	0	1	01	01	H5253_084_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	084	0	1	01	01	H5253_084_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	084	0	1	01	01	H5253_084_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	084	0	1	01	01	H5253_084_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				773.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	085	0	1	01	01	H5253_085_0	5	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	085	0	1	01	01	H5253_085_0	5	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	085	0	1	01	01	H5253_085_0	5	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		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	085	0	1	01	01	H5253_085_0	5	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	085	0	1	01	01	H5253_085_0	5	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				865.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	086	0	1	01	01	H5253_086_0	5	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	086	0	1	01	01	H5253_086_0	5	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	086	0	1	01	01	H5253_086_0	5	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	086	0	1	01	01	H5253_086_0	5	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	086	0	1	01	01	H5253_086_0	5	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				760.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	087	0	1	01	01	H5253_087_0	5	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	087	0	1	01	01	H5253_087_0	5	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	087	0	1	01	01	H5253_087_0	5	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	087	0	1	01	01	H5253_087_0	5	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	087	0	1	01	01	H5253_087_0	5	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				909.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	088	0	1	01	01	H5253_088_0	5	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	088	0	1	01	01	H5253_088_0	5	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	088	0	1	01	01	H5253_088_0	5	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		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	088	0	1	01	01	H5253_088_0	5	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	088	0	1	01	01	H5253_088_0	5	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				819.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	089	0	1	01	01	H5253_089_0	5	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	089	0	1	01	01	H5253_089_0	5	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	089	0	1	01	01	H5253_089_0	5	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	089	0	1	01	01	H5253_089_0	5	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	089	0	1	01	01	H5253_089_0	5	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				865.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	090	0	1	01	01	H5253_090_0	5	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	090	0	1	01	01	H5253_090_0	5	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	090	0	1	01	01	H5253_090_0	5	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	090	0	1	01	01	H5253_090_0	5	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5253	090	0	1	01	01	H5253_090_0	5	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				994.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	001	0	1	01	01	H5262_001_0	8	Preferred Generic	4	001000	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	3.00	6.00	9.00																					7.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	001	0	1	01	01	H5262_001_0	8	Generic	4	010000	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	15.00	30.00	45.00																					38.00																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	001	0	1	01	01	H5262_001_0	8	Preferred Brand	4	000001	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	45.00	90.00	135.00																					113.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	001	0	1	01	01	H5262_001_0	8	Non-Preferred Drug	4	100100	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				31.44	40	40	40																				40															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	001	0	1	01	01	H5262_001_0	8	Specialty Tier	4	010010	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												
H5262	003	0	1	01	01	H5262_003_0	9	Preferred Generic	4	001000	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	3.00	6.00	9.00																					7.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	003	0	1	01	01	H5262_003_0	9	Generic	4	010000	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	15.00	30.00	45.00																					38.00																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	003	0	1	01	01	H5262_003_0	9	Preferred Brand	4	000001	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	45.00	90.00	135.00																					113.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	003	0	1	01	01	H5262_003_0	9	Non-Preferred Drug	4	100100	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				40.74	40	40	40																				40															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	003	0	1	01	01	H5262_003_0	9	Specialty Tier	4	010010	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												
H5262	007	0	1	01	01	H5262_007_0	9	Preferred Generic	4	001000	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	6.00	12.00	18.00																					15.00																6.00				6.00		0.20						0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	007	0	1	01	01	H5262_007_0	9	Generic	4	010000	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	15.00	30.00	45.00																					38.00																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	007	0	1	01	01	H5262_007_0	9	Preferred Brand	4	000001	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					118.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	007	0	1	01	01	H5262_007_0	9	Non-Preferred Drug	4	100100	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				29.55	40	40	40																				40															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	007	0	1	01	01	H5262_007_0	9	Specialty Tier	4	010010	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												
H5262	008	0	1	01	01	H5262_008_0	9	Preferred Generic	4	001000	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	6.00	12.00	18.00																					15.00																6.00				6.00		0.20						0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	008	0	1	01	01	H5262_008_0	9	Generic	4	010000	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	15.00	30.00	45.00																					38.00																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	008	0	1	01	01	H5262_008_0	9	Preferred Brand	4	000001	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					118.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	008	0	1	01	01	H5262_008_0	9	Non-Preferred Drug	4	100100	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				35.41	40	40	40																				40															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	008	0	1	01	01	H5262_008_0	9	Specialty Tier	4	010010	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												
H5262	011	0	1	01	01	H5262_011_0	9	Preferred Generic	4	001000	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	3.00	6.00	9.00																					7.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	011	0	1	01	01	H5262_011_0	9	Generic	4	010000	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	12.00	24.00	36.00																					30.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	011	0	1	01	01	H5262_011_0	9	Preferred Brand	4	000001	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					118.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	011	0	1	01	01	H5262_011_0	9	Non-Preferred Drug	4	100100	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				37.43	40	40	40																				40															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	011	0	1	01	01	H5262_011_0	9	Specialty Tier	4	010010	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												
H5262	012	0	1	01	01	H5262_012_0	11	Preferred Generic	4	001000	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	3.00	6.00	9.00																					7.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	012	0	1	01	01	H5262_012_0	11	Generic	4	010000	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	12.00	24.00	36.00																					30.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	012	0	1	01	01	H5262_012_0	11	Preferred Brand	4	000001	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					118.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	012	0	1	01	01	H5262_012_0	11	Non-Preferred Drug	4	100100	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				44.83	40	40	40																				40															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5262	012	0	1	01	01	H5262_012_0	11	Specialty Tier	4	010010	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												
H5280	001	0	1	48	05	H5280_001_0	5	Generic Drugs	4	010000			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	5	Brand Drugs	4	010010			2	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	5	Non-Medicare Rx/OTC Drugs	4	010010			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	001	0	1	01	01	H5294_001_0	12	Preferred Generic	3	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5294	001	0	1	01	01	H5294_001_0	12	Generic	3	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	19.00	38.00	57.00																			19.00	38.00	57.00																19.00				19.00		0.63			0.63			0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5294	001	0	1	01	01	H5294_001_0	12	Preferred Brand	3	000001	1	2	3	1	111		01	111		1	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												
H5294	001	0	1	01	01	H5294_001_0	12	Non-Preferred Brand	3	100000	1	2	4	1	111		01	111		1	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												
H5294	001	0	1	01	01	H5294_001_0	12	Specialty Tier	3	010010	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												
H5302	011	0	1	01	01	H5302_011_0	5	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5302	011	0	1	01	01	H5302_011_0	5	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5302	011	0	1	01	01	H5302_011_0	5	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5302	011	0	1	01	01	H5302_011_0	5	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5302	011	0	1	01	01	H5302_011_0	5	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5302	011	0	1	01	01	H5302_011_0	5	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5302	011	0	1	01	01	H5302_011_0	5	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5322	024	0	1	01	01	H5322_024_0	5	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5322	024	0	1	01	01	H5322_024_0	5	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5322	024	0	1	01	01	H5322_024_0	5	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5322	024	0	1	01	01	H5322_024_0	5	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5322	024	0	1	01	01	H5322_024_0	5	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				723.00	27		27																										27						27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5355	001	0	1	48	05	H5355_001_0	8	Generic Drugs	4	010000			1	1	110		01	110		1	30		90				2	2	30		90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	3.30	0.00	3.30	0.00	3.30	0.00	3.30			
H5355	001	0	1	48	05	H5355_001_0	8	Brand Drugs	4	000010			2	1	110		01	110		1	30		90				2	2	30		90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	8.25	0.00	8.25	0.00	8.25	0.00	8.25			
H5355	001	0	1	48	05	H5355_001_0	8	Non-Medicare Rx/OTC Drugs	4	010010			3	1	110		01	110		1	30		90				1	2	30		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			
H5386	003	0	1	01	01	H5386_003_0	3	Preferred Generic	4	001000	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		34	4.00	8.00	12.00																					0.00																4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5386	003	0	1	01	01	H5386_003_0	3	Generic	4	010000	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		34	8.00	16.00	24.00																					0.00																8.00				8.00		0.27						0.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5386	003	0	1	01	01	H5386_003_0	3	Preferred Brand	4	000001	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		34	47.00	94.00	141.00																					94.00																47.00				47.00		1.57						1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5386	003	0	1	01	01	H5386_003_0	3	Non-Preferred Brand	4	100000	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		34	100.00	200.00	300.00																					200.00																100.00				100.00		3.33						2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5386	003	0	1	01	01	H5386_003_0	3	Specialty Tier	4	010010	1	1	5	1	010		01			1	30														30		34					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5386	004	0	1	01	01	H5386_004_0	3	Preferred Generic	4	001000	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		34	3.00	6.00	9.00																					0.00																3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5386	004	0	1	01	01	H5386_004_0	3	Generic	4	010000	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		34	6.00	12.00	18.00																					0.00																6.00				6.00		0.20						0.18	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5386	004	0	1	01	01	H5386_004_0	3	Preferred Brand	4	000001	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		34	47.00	94.00	141.00																					94.00																47.00				47.00		1.57						1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5386	004	0	1	01	01	H5386_004_0	3	Non-Preferred Brand	4	100000	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		34	100.00	200.00	300.00																					200.00																100.00				100.00		3.33						2.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5386	004	0	1	01	01	H5386_004_0	3	Specialty Tier	4	010010	1	1	5	1	010		01			1	30														30		34					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5410	001	0	1	01	01	H5410_001_0	6	Generic	4	010010	3	2	1	1		110	01			1				30		90	1	2							30		31								5.00		15.00					0.00		0.00																							5.00				5.00			0.17	0.00				0.16	Generic, Brand, Specialty Tier												
H5410	001	0	1	01	01	H5410_001_0	6	Generic	4	010010	3	2	1	3		110	01			1				30		90	1	2							30		31								5.00		15.00					0.00		0.00																							5.00				5.00			0.17	0.00				0.16	Generic, Brand, Specialty Tier										1		3
H5410	001	0	1	01	01	H5410_001_0	6	Brand	4	000010	1	2	2	1		110	01			1				30		90	1	2							30		31								10.00		30.00					0.00		0.00																							10.00				10.00			0.33	0.00				0.32	Generic, Brand, Specialty Tier												
H5410	001	0	1	01	01	H5410_001_0	6	Specialty Tier	4	010010	1	1	3	1		010	01			1				30											30		31											846.76	33						650.75	33																							33			33								Generic, Brand, Specialty Tier												
H5410	018	0	1	02	01	H5410_018_0	5	Preferred Generic	4	001000	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		31								6.00	12.00	6.00					1.00	2.00	1.00					6.00		6.00																6.00				6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	018	0	1	02	01	H5410_018_0	5	Preferred Generic	4	001000	1	2	1	3		111	01	110		1				30	60	90	1	2	30		90				30		31								6.00	12.00	6.00					1.00	2.00	1.00					6.00		6.00																6.00				6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5410	018	0	1	02	01	H5410_018_0	5	Generic	4	010000	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		31								15.00	30.00	15.00					9.00	18.00	9.00					15.00		15.00																15.00				15.00			0.50	0.30	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	018	0	1	02	01	H5410_018_0	5	Preferred Brand	4	000101	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					47.00		141.00																47.00				47.00			1.57	1.40	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	018	0	1	02	01	H5410_018_0	5	Non-Preferred Drug	4	100100	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		31								95.00	190.00	285.00					90.00	180.00	270.00					95.00		285.00																95.00				95.00			3.17	3.00	3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5410	018	0	1	02	01	H5410_018_0	5	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		31											588.01	30						480.64	30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5415	056	0	1	04	01	H5415_056_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5415	056	0	1	04	01	H5415_056_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5415	056	0	1	04	01	H5415_056_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5415	056	0	1	04	01	H5415_056_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5415	056	0	1	04	01	H5415_056_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5415	056	0	1	04	01	H5415_056_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5415	056	0	1	04	01	H5415_056_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5415	056	0	1	04	01	H5415_056_0	4	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5415	056	0	1	04	01	H5415_056_0	4	Specialty Tier	4	010010	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												
H5415	056	0	1	04	01	H5415_056_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5415	070	0	1	04	01	H5415_070_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5415	070	0	1	04	01	H5415_070_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5415	070	0	1	04	01	H5415_070_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5415	070	0	1	04	01	H5415_070_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5415	070	0	1	04	01	H5415_070_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5415	070	0	1	04	01	H5415_070_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5415	070	0	1	04	01	H5415_070_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5415	070	0	1	04	01	H5415_070_0	4	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5415	070	0	1	04	01	H5415_070_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5415	070	0	1	04	01	H5415_070_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5415	071	0	1	04	01	H5415_071_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								9.00		27.00					4.00		12.00											9.00		27.00				4.00		0.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5415	071	0	1	04	01	H5415_071_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								9.00		27.00					4.00		12.00											9.00		27.00				4.00		0.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5415	071	0	1	04	01	H5415_071_0	3	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5415	071	0	1	04	01	H5415_071_0	3	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5415	071	0	1	04	01	H5415_071_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5415	071	0	1	04	01	H5415_071_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5415	071	0	1	04	01	H5415_071_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5415	071	0	1	04	01	H5415_071_0	3	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5415	071	0	1	04	01	H5415_071_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5415	071	0	1	04	01	H5415_071_0	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5415	072	0	1	04	01	H5415_072_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								7.00		21.00					2.00		6.00											7.00		21.00				2.00		0.00				7.00				7.00			0.23	0.07		0.23	0.07	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5415	072	0	1	04	01	H5415_072_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								7.00		21.00					2.00		6.00											7.00		21.00				2.00		0.00				7.00				7.00			0.23	0.07		0.23	0.07	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5415	072	0	1	04	01	H5415_072_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								17.00		51.00					12.00		36.00											17.00		51.00				12.00		0.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5415	072	0	1	04	01	H5415_072_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								17.00		51.00					12.00		36.00											17.00		51.00				12.00		0.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5415	072	0	1	04	01	H5415_072_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5415	072	0	1	04	01	H5415_072_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5415	072	0	1	04	01	H5415_072_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5415	072	0	1	04	01	H5415_072_0	4	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5415	072	0	1	04	01	H5415_072_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5415	072	0	1	04	01	H5415_072_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5415	073	0	1	04	01	H5415_073_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								9.00		27.00					4.00		12.00											9.00		27.00				4.00		0.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5415	073	0	1	04	01	H5415_073_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								9.00		27.00					4.00		12.00											9.00		27.00				4.00		0.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5415	073	0	1	04	01	H5415_073_0	3	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5415	073	0	1	04	01	H5415_073_0	3	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5415	073	0	1	04	01	H5415_073_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5415	073	0	1	04	01	H5415_073_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5415	073	0	1	04	01	H5415_073_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5415	073	0	1	04	01	H5415_073_0	3	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5415	073	0	1	04	01	H5415_073_0	3	Specialty Tier	4	010010	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												
H5415	073	0	1	04	01	H5415_073_0	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5415	074	0	1	04	01	H5415_074_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								9.00		27.00					4.00		12.00											9.00		27.00				4.00		0.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5415	074	0	1	04	01	H5415_074_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								9.00		27.00					4.00		12.00											9.00		27.00				4.00		0.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5415	074	0	1	04	01	H5415_074_0	3	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5415	074	0	1	04	01	H5415_074_0	3	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5415	074	0	1	04	01	H5415_074_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5415	074	0	1	04	01	H5415_074_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5415	074	0	1	04	01	H5415_074_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5415	074	0	1	04	01	H5415_074_0	3	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5415	074	0	1	04	01	H5415_074_0	3	Specialty Tier	4	010010	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												
H5415	074	0	1	04	01	H5415_074_0	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5415	075	0	1	04	01	H5415_075_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								7.00		21.00					2.00		6.00											7.00		21.00				2.00		0.00				7.00				7.00			0.23	0.07		0.23	0.07	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5415	075	0	1	04	01	H5415_075_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								7.00		21.00					2.00		6.00											7.00		21.00				2.00		0.00				7.00				7.00			0.23	0.07		0.23	0.07	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5415	075	0	1	04	01	H5415_075_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								17.00		51.00					12.00		36.00											17.00		51.00				12.00		0.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5415	075	0	1	04	01	H5415_075_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								17.00		51.00					12.00		36.00											17.00		51.00				12.00		0.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5415	075	0	1	04	01	H5415_075_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5415	075	0	1	04	01	H5415_075_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5415	075	0	1	04	01	H5415_075_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5415	075	0	1	04	01	H5415_075_0	4	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5415	075	0	1	04	01	H5415_075_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5415	075	0	1	04	01	H5415_075_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5415	076	0	1	04	01	H5415_076_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								7.00		21.00					2.00		6.00											7.00		21.00				2.00		0.00				7.00				7.00			0.23	0.07		0.23	0.07	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5415	076	0	1	04	01	H5415_076_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								7.00		21.00					2.00		6.00											7.00		21.00				2.00		0.00				7.00				7.00			0.23	0.07		0.23	0.07	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5415	076	0	1	04	01	H5415_076_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								17.00		51.00					12.00		36.00											17.00		51.00				12.00		0.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5415	076	0	1	04	01	H5415_076_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								17.00		51.00					12.00		36.00											17.00		51.00				12.00		0.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5415	076	0	1	04	01	H5415_076_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5415	076	0	1	04	01	H5415_076_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5415	076	0	1	04	01	H5415_076_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5415	076	0	1	04	01	H5415_076_0	4	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5415	076	0	1	04	01	H5415_076_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5415	076	0	1	04	01	H5415_076_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5415	077	0	1	04	01	H5415_077_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5415	077	0	1	04	01	H5415_077_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5415	077	0	1	04	01	H5415_077_0	3	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5415	077	0	1	04	01	H5415_077_0	3	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5415	077	0	1	04	01	H5415_077_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5415	077	0	1	04	01	H5415_077_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5415	077	0	1	04	01	H5415_077_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5415	077	0	1	04	01	H5415_077_0	3	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5415	077	0	1	04	01	H5415_077_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5415	077	0	1	04	01	H5415_077_0	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5420	001	0	1	01	01	H5420_001_0	4	Preferred Generic	4	001000	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5420	001	0	1	01	01	H5420_001_0	4	Preferred Generic	4	001000	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5420	001	0	1	01	01	H5420_001_0	4	Generic	4	010000	3	2	2	1	110		01		100	1	30		90				1	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5420	001	0	1	01	01	H5420_001_0	4	Generic	4	010000	3	2	2	3	110		01		100	1	30		90				1	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5420	001	0	1	01	01	H5420_001_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	30.00		90.00																											90.00						80.00				30.00				30.00		1.00						0.96	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5420	001	0	1	01	01	H5420_001_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	55.00		165.00																											165.00						155.00				55.00				55.00		1.83						1.77	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5420	001	0	1	01	01	H5420_001_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				850.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5420	003	0	1	01	01	H5420_003_0	4	Preferred Generic	4	001000	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5420	003	0	1	01	01	H5420_003_0	4	Preferred Generic	4	001000	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5420	003	0	1	01	01	H5420_003_0	4	Generic	4	010000	3	2	2	1	110		01		100	1	30		90				1	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5420	003	0	1	01	01	H5420_003_0	4	Generic	4	010000	3	2	2	3	110		01		100	1	30		90				1	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5420	003	0	1	01	01	H5420_003_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	40.00		120.00																											120.00						110.00				40.00				40.00		1.33						1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5420	003	0	1	01	01	H5420_003_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	89.00		267.00																											267.00						257.00				89.00				89.00		2.96						2.87	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5420	003	0	1	01	01	H5420_003_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				782.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5420	006	0	1	01	01	H5420_006_0	4	Preferred Generic	4	001000	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												
H5420	006	0	1	01	01	H5420_006_0	4	Preferred Generic	4	001000	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5420	006	0	1	01	01	H5420_006_0	4	Generic	4	010000	3	2	2	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5420	006	0	1	01	01	H5420_006_0	4	Generic	4	010000	3	2	2	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5420	006	0	1	01	01	H5420_006_0	4	Preferred Brand	4	010001	1	1	3	1	110		01	100		1	30		90				1	2			90				30		31				44.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5420	006	0	1	01	01	H5420_006_0	4	Non-Preferred Drug	4	100100	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				53.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5420	006	0	1	01	01	H5420_006_0	4	Specialty Tier	4	010010	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31				764.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5422	007	0	1	01	01	H5422_007_0	7	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5422	007	0	1	01	01	H5422_007_0	7	Generic	4	010000	1	2	2	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												
H5422	007	0	1	01	01	H5422_007_0	7	Preferred Brand	4	000101	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												
H5422	007	0	1	01	01	H5422_007_0	7	Non-Preferred Drug	4	100100	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												
H5422	007	0	1	01	01	H5422_007_0	7	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5422	007	0	1	01	01	H5422_007_0	7	Select Care Drugs	4	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5422	007	0	1	01	01	H5422_007_0	7	Select Care Drugs	4	001000	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5422	008	0	1	01	01	H5422_008_0	7	Preferred Generic	4	001000	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												
H5422	008	0	1	01	01	H5422_008_0	7	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	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	008	0	1	01	01	H5422_008_0	7	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	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	008	0	1	01	01	H5422_008_0	7	Non-Preferred Drug	4	100100	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												
H5422	008	0	1	01	01	H5422_008_0	7	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		34												31							31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5422	008	0	1	01	01	H5422_008_0	7	Select Care Drugs	4	001000	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			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	Select Care Drugs	4	001000	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5422	009	0	1	01	01	H5422_009_0	10	Preferred Generic	4	001000	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												
H5422	009	0	1	01	01	H5422_009_0	10	Preferred Generic	4	001000	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		
H5422	009	0	1	01	01	H5422_009_0	10	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					12.00	24.00	36.00					12.00	36.00	36.00																17.00				17.00			0.57	0.40	0.40			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5422	009	0	1	01	01	H5422_009_0	10	Generic	4	010000	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					12.00	24.00	36.00					12.00	36.00	36.00																17.00				17.00			0.57	0.40	0.40			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5422	009	0	1	01	01	H5422_009_0	10	Preferred Brand	4	000001	1	2	3	1		111	01	111		1				30	60	90	1	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	009	0	1	01	01	H5422_009_0	10	Non-Preferred Drug	4	100100	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												
H5422	009	0	1	01	01	H5422_009_0	10	Specialty Tier	4	010010	1	1	5	1		010	01	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	009	0	1	01	01	H5422_009_0	10	Select Care Drugs	4	010010	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5422	009	0	1	01	01	H5422_009_0	10	Select Care Drugs	4	010010	1	2	6	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		
H5425	001	0	1	01	01	H5425_001_0	7	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	14.00					2.00	4.00	4.00					2.00	4.00	4.00																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												
H5425	001	0	1	01	01	H5425_001_0	7	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	24.00					5.00	10.00	10.00					5.00	10.00	10.00																12.00				12.00			0.40	0.17	0.17			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	001	0	1	01	01	H5425_001_0	7	Preferred Brand	4	010001	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	131.00					42.00	84.00	116.00					42.00	84.00	116.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	001	0	1	01	01	H5425_001_0	7	Non-Preferred Drug	4	100100	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	290.00					95.00	190.00	275.00					95.00	190.00	275.00																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	001	0	1	01	01	H5425_001_0	7	Specialty Tier	4	010010	1	1	5	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												
H5425	001	0	1	01	01	H5425_001_0	7	Select Care Drugs	4	000010	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								11.00	22.00	23.00					11.00	22.00	23.00					11.00	22.00	23.00																11.00				11.00			0.37	0.37	0.37			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	004	0	1	01	01	H5425_004_0	5	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	10.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	004	0	1	01	01	H5425_004_0	5	Preferred Generic	4	001000	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	10.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5425	004	0	1	01	01	H5425_004_0	5	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	16.00					3.00	6.00	6.00					3.00	6.00	6.00																8.00				8.00			0.27	0.10	0.10			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	004	0	1	01	01	H5425_004_0	5	Generic	4	010000	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	16.00					3.00	6.00	6.00					3.00	6.00	6.00																8.00				8.00			0.27	0.10	0.10			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5425	004	0	1	01	01	H5425_004_0	5	Preferred Brand	4	010001	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	131.00					42.00	84.00	116.00					42.00	84.00	116.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	004	0	1	01	01	H5425_004_0	5	Non-Preferred Drug	4	100100	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	290.00					95.00	190.00	275.00					95.00	190.00	275.00																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	004	0	1	01	01	H5425_004_0	5	Specialty Tier	4	010010	1	1	5	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												
H5425	004	0	1	01	01	H5425_004_0	5	Select Care Drugs	4	000010	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								11.00	22.00	23.00					11.00	22.00	23.00					11.00	22.00	23.00																11.00				11.00			0.37	0.37	0.37			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	005	0	1	01	01	H5425_005_0	6	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	10.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	005	0	1	01	01	H5425_005_0	6	Generic	4	010000	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					5.00	10.00	10.00																10.00				10.00			0.33	0.17	0.17			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	005	0	1	01	01	H5425_005_0	6	Preferred Brand	4	010001	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	131.00					42.00	84.00	116.00					42.00	84.00	116.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	005	0	1	01	01	H5425_005_0	6	Non-Preferred Drug	4	100100	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	290.00					95.00	190.00	275.00					95.00	190.00	275.00																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	005	0	1	01	01	H5425_005_0	6	Specialty Tier	4	010010	1	1	5	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												
H5425	005	0	1	01	01	H5425_005_0	6	Select Care Drugs	4	000010	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								11.00	22.00	23.00					11.00	22.00	23.00					11.00	22.00	23.00																11.00				11.00			0.37	0.37	0.37			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	006	0	1	01	01	H5425_006_0	6	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	006	0	1	01	01	H5425_006_0	6	Preferred Generic	4	001000	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, Select Care Drugs										1		
H5425	006	0	1	01	01	H5425_006_0	6	Generic	4	010000	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					5.00	10.00	10.00																10.00				10.00			0.33	0.17	0.17			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	006	0	1	01	01	H5425_006_0	6	Generic	4	010000	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	20.00					5.00	10.00	10.00					5.00	10.00	10.00																10.00				10.00			0.33	0.17	0.17			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5425	006	0	1	01	01	H5425_006_0	6	Preferred Brand	4	010001	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	131.00					42.00	84.00	116.00					42.00	84.00	116.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	006	0	1	01	01	H5425_006_0	6	Non-Preferred Drug	4	100100	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	290.00					95.00	190.00	275.00					95.00	190.00	275.00																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	006	0	1	01	01	H5425_006_0	6	Specialty Tier	4	010010	1	1	5	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												
H5425	006	0	1	01	01	H5425_006_0	6	Select Care Drugs	4	000010	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								11.00	22.00	23.00					11.00	22.00	23.00					11.00	22.00	23.00																11.00				11.00			0.37	0.37	0.37			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	007	0	1	01	01	H5425_007_0	6	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	007	0	1	01	01	H5425_007_0	6	Preferred Generic	4	001000	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, Select Care Drugs										1		
H5425	007	0	1	01	01	H5425_007_0	6	Generic	4	010000	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					5.00	10.00	10.00																10.00				10.00			0.33	0.17	0.17			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	007	0	1	01	01	H5425_007_0	6	Generic	4	010000	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	20.00					5.00	10.00	10.00					5.00	10.00	10.00																10.00				10.00			0.33	0.17	0.17			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5425	007	0	1	01	01	H5425_007_0	6	Preferred Brand	4	010001	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	131.00					42.00	84.00	116.00					42.00	84.00	116.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	007	0	1	01	01	H5425_007_0	6	Non-Preferred Drug	4	100100	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	290.00					95.00	190.00	275.00					95.00	190.00	275.00																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	007	0	1	01	01	H5425_007_0	6	Specialty Tier	4	010010	1	1	5	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												
H5425	007	0	1	01	01	H5425_007_0	6	Select Care Drugs	4	000010	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								11.00	22.00	23.00					11.00	22.00	23.00					11.00	22.00	23.00																11.00				11.00			0.37	0.37	0.37			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	008	0	1	01	01	H5425_008_0	6	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	10.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	008	0	1	01	01	H5425_008_0	6	Preferred Generic	4	001000	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	10.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5425	008	0	1	01	01	H5425_008_0	6	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	24.00					7.00	14.00	14.00					7.00	14.00	14.00																12.00				12.00			0.40	0.23	0.23			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	008	0	1	01	01	H5425_008_0	6	Generic	4	010000	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	24.00					7.00	14.00	14.00					7.00	14.00	14.00																12.00				12.00			0.40	0.23	0.23			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5425	008	0	1	01	01	H5425_008_0	6	Preferred Brand	4	010001	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	131.00					42.00	84.00	116.00					42.00	84.00	116.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	008	0	1	01	01	H5425_008_0	6	Non-Preferred Drug	4	100100	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	290.00					95.00	190.00	275.00					95.00	190.00	275.00																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	008	0	1	01	01	H5425_008_0	6	Specialty Tier	4	010010	1	1	5	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												
H5425	008	0	1	01	01	H5425_008_0	6	Select Care Drugs	4	000010	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								11.00	22.00	23.00					11.00	22.00	23.00					11.00	22.00	23.00																11.00				11.00			0.37	0.37	0.37			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	009	0	1	01	01	H5425_009_0	6	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	10.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	009	0	1	01	01	H5425_009_0	6	Preferred Generic	4	001000	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	10.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5425	009	0	1	01	01	H5425_009_0	6	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	24.00					7.00	14.00	14.00					7.00	14.00	14.00																12.00				12.00			0.40	0.23	0.23			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	009	0	1	01	01	H5425_009_0	6	Generic	4	010000	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	24.00					7.00	14.00	14.00					7.00	14.00	14.00																12.00				12.00			0.40	0.23	0.23			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5425	009	0	1	01	01	H5425_009_0	6	Preferred Brand	4	010001	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	131.00					42.00	84.00	116.00					42.00	84.00	116.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	009	0	1	01	01	H5425_009_0	6	Non-Preferred Drug	4	100100	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	290.00					95.00	190.00	275.00					95.00	190.00	275.00																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	009	0	1	01	01	H5425_009_0	6	Specialty Tier	4	010010	1	1	5	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												
H5425	009	0	1	01	01	H5425_009_0	6	Select Care Drugs	4	000010	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								11.00	22.00	23.00					11.00	22.00	23.00					11.00	22.00	23.00																11.00				11.00			0.37	0.37	0.37			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	010	0	1	01	01	H5425_010_0	6	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								19.00	38.00	57.00					0.00	0.00	0.00					0.00	0.00	0.00																19.00				19.00			0.63	0.00	0.00			0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	010	0	1	01	01	H5425_010_0	6	Preferred Generic	4	001000	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								19.00	38.00	57.00					0.00	0.00	0.00					0.00	0.00	0.00																19.00				19.00			0.63	0.00	0.00			0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5425	010	0	1	01	01	H5425_010_0	6	Generic	4	010000	1	1	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											6.42	25	25	25				6.42	25	25	25				25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	010	0	1	01	01	H5425_010_0	6	Preferred Brand	4	010001	1	1	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											65.62	25	25	25				65.62	25	25	25				25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	010	0	1	01	01	H5425_010_0	6	Non-Preferred Drug	4	100100	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											91.03	25	25	25				91.03	25	25	25				25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	010	0	1	01	01	H5425_010_0	6	Specialty Tier	4	010010	1	1	5	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												
H5425	010	0	1	01	01	H5425_010_0	6	Select Care Drugs	4	000010	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				11.00			0.37	0.37	0.37			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	019	0	1	01	01	H5425_019_0	5	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	16.00					3.00	6.00	6.00					3.00	6.00	6.00																8.00				8.00			0.27	0.10	0.10			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	019	0	1	01	01	H5425_019_0	5	Generic	4	010000	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					5.00	10.00	10.00																10.00				10.00			0.33	0.17	0.17			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	019	0	1	01	01	H5425_019_0	5	Preferred Brand	4	010001	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	131.00					42.00	84.00	116.00					42.00	84.00	116.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	019	0	1	01	01	H5425_019_0	5	Non-Preferred Drug	4	100100	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	290.00					95.00	190.00	275.00					95.00	190.00	275.00																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	019	0	1	01	01	H5425_019_0	5	Specialty Tier	4	010010	1	1	5	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												
H5425	019	0	1	01	01	H5425_019_0	5	Select Care Drugs	4	000010	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								11.00	22.00	23.00					11.00	22.00	23.00					11.00	22.00	23.00																11.00				11.00			0.37	0.37	0.37			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	020	0	1	01	01	H5425_020_0	6	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	16.00					3.00	6.00	6.00					3.00	6.00	6.00																8.00				8.00			0.27	0.10	0.10			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	020	0	1	01	01	H5425_020_0	6	Generic	4	010000	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					5.00	10.00	10.00																10.00				10.00			0.33	0.17	0.17			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	020	0	1	01	01	H5425_020_0	6	Preferred Brand	4	010001	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	131.00					42.00	84.00	116.00					42.00	84.00	116.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	020	0	1	01	01	H5425_020_0	6	Non-Preferred Drug	4	100100	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	290.00					95.00	190.00	275.00					95.00	190.00	275.00																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	020	0	1	01	01	H5425_020_0	6	Specialty Tier	4	010010	1	1	5	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												
H5425	020	0	1	01	01	H5425_020_0	6	Select Care Drugs	4	000010	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								11.00	22.00	23.00					11.00	22.00	23.00					11.00	22.00	23.00																11.00				11.00			0.37	0.37	0.37			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	028	0	1	01	01	H5425_028_0	6	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								3.00	6.00	6.00					0.00	0.00	0.00					0.00	0.00	0.00																3.00				3.00			0.10	0.00	0.00			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	028	0	1	01	01	H5425_028_0	6	Preferred Generic	4	001000	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								3.00	6.00	6.00					0.00	0.00	0.00					0.00	0.00	0.00																3.00				3.00			0.10	0.00	0.00			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5425	028	0	1	01	01	H5425_028_0	6	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	14.00					2.00	4.00	4.00					2.00	4.00	4.00																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												
H5425	028	0	1	01	01	H5425_028_0	6	Generic	4	010000	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	14.00					2.00	4.00	4.00					2.00	4.00	4.00																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										1		
H5425	028	0	1	01	01	H5425_028_0	6	Preferred Brand	4	010001	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	131.00					42.00	84.00	116.00					42.00	84.00	116.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	028	0	1	01	01	H5425_028_0	6	Non-Preferred Drug	4	100100	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	290.00					95.00	190.00	275.00					95.00	190.00	275.00																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	028	0	1	01	01	H5425_028_0	6	Specialty Tier	4	010010	1	1	5	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												
H5425	028	0	1	01	01	H5425_028_0	6	Select Care Drugs	4	000010	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	028	0	1	01	01	H5425_028_0	6	Select Care Drugs	4	000010	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5425	029	0	1	01	01	H5425_029_0	6	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.50	17.00	25.50					0.00	0.00	0.00					0.00	0.00	0.00																8.50				8.50			0.28	0.00	0.00			0.27	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	029	0	1	01	01	H5425_029_0	6	Preferred Generic	4	001000	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.50	17.00	25.50					0.00	0.00	0.00					0.00	0.00	0.00																8.50				8.50			0.28	0.00	0.00			0.27	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5425	029	0	1	01	01	H5425_029_0	6	Generic	4	010000	1	1	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											5.97	25	25	25				5.97	25	25	25				25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	029	0	1	01	01	H5425_029_0	6	Preferred Brand	4	010001	1	1	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											62.32	25	25	25				62.32	25	25	25				25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	029	0	1	01	01	H5425_029_0	6	Non-Preferred Drug	4	100100	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											67.19	25	25	25				67.19	25	25	25				25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	029	0	1	01	01	H5425_029_0	6	Specialty Tier	4	010010	1	1	5	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												
H5425	029	0	1	01	01	H5425_029_0	6	Select Care Drugs	4	000010	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				11.00			0.37	0.37	0.37			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	030	0	1	01	01	H5425_030_0	6	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								19.00	38.00	57.00					0.00	0.00	0.00					0.00	0.00	0.00																19.00				19.00			0.63	0.00	0.00			0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	030	0	1	01	01	H5425_030_0	6	Preferred Generic	4	001000	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								19.00	38.00	57.00					0.00	0.00	0.00					0.00	0.00	0.00																19.00				19.00			0.63	0.00	0.00			0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5425	030	0	1	01	01	H5425_030_0	6	Generic	4	010000	1	1	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											6.10	25	25	25				6.10	25	25	25				25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	030	0	1	01	01	H5425_030_0	6	Preferred Brand	4	010001	1	1	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											62.95	25	25	25				62.95	25	25	25				25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	030	0	1	01	01	H5425_030_0	6	Non-Preferred Drug	4	100100	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											62.93	25	25	25				62.93	25	25	25				25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	030	0	1	01	01	H5425_030_0	6	Specialty Tier	4	010010	1	1	5	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												
H5425	030	0	1	01	01	H5425_030_0	6	Select Care Drugs	4	000010	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				11.00			0.37	0.37	0.37			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	031	0	1	01	01	H5425_031_0	6	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								19.00	38.00	57.00					0.00	0.00	0.00					0.00	0.00	0.00																19.00				19.00			0.63	0.00	0.00			0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	031	0	1	01	01	H5425_031_0	6	Preferred Generic	4	001000	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								19.00	38.00	57.00					0.00	0.00	0.00					0.00	0.00	0.00																19.00				19.00			0.63	0.00	0.00			0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5425	031	0	1	01	01	H5425_031_0	6	Generic	4	010000	1	1	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											5.87	25	25	25				5.87	25	25	25				25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	031	0	1	01	01	H5425_031_0	6	Preferred Brand	4	010001	1	1	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											61.53	25	25	25				61.53	25	25	25				25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	031	0	1	01	01	H5425_031_0	6	Non-Preferred Drug	4	100100	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											64.81	25	25	25				64.81	25	25	25				25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	031	0	1	01	01	H5425_031_0	6	Specialty Tier	4	010010	1	1	5	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												
H5425	031	0	1	01	01	H5425_031_0	6	Select Care Drugs	4	000010	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				11.00			0.37	0.37	0.37			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	033	0	1	01	01	H5425_033_0	6	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	10.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	033	0	1	01	01	H5425_033_0	6	Preferred Generic	4	001000	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	10.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5425	033	0	1	01	01	H5425_033_0	6	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	24.00					7.00	14.00	14.00					7.00	14.00	14.00																12.00				12.00			0.40	0.23	0.23			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	033	0	1	01	01	H5425_033_0	6	Generic	4	010000	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	24.00					7.00	14.00	14.00					7.00	14.00	14.00																12.00				12.00			0.40	0.23	0.23			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5425	033	0	1	01	01	H5425_033_0	6	Preferred Brand	4	010001	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	131.00					42.00	84.00	116.00					42.00	84.00	116.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	033	0	1	01	01	H5425_033_0	6	Non-Preferred Drug	4	100100	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	290.00					95.00	190.00	275.00					95.00	190.00	275.00																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	033	0	1	01	01	H5425_033_0	6	Specialty Tier	4	010010	1	1	5	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												
H5425	033	0	1	01	01	H5425_033_0	6	Select Care Drugs	4	000010	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								11.00	22.00	23.00					11.00	22.00	23.00					11.00	22.00	23.00																11.00				11.00			0.37	0.37	0.37			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	034	0	1	01	01	H5425_034_0	6	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								3.00	6.00	6.00					0.00	0.00	0.00					0.00	0.00	0.00																3.00				3.00			0.10	0.00	0.00			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	034	0	1	01	01	H5425_034_0	6	Preferred Generic	4	001000	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								3.00	6.00	6.00					0.00	0.00	0.00					0.00	0.00	0.00																3.00				3.00			0.10	0.00	0.00			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5425	034	0	1	01	01	H5425_034_0	6	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	14.00					2.00	4.00	4.00					2.00	4.00	4.00																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												
H5425	034	0	1	01	01	H5425_034_0	6	Generic	4	010000	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	14.00					2.00	4.00	4.00					2.00	4.00	4.00																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										1		
H5425	034	0	1	01	01	H5425_034_0	6	Preferred Brand	4	010001	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	131.00					42.00	84.00	116.00					42.00	84.00	116.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	034	0	1	01	01	H5425_034_0	6	Non-Preferred Drug	4	100100	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	290.00					95.00	190.00	275.00					95.00	190.00	275.00																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	034	0	1	01	01	H5425_034_0	6	Specialty Tier	4	010010	1	1	5	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												
H5425	034	0	1	01	01	H5425_034_0	6	Select Care Drugs	4	000010	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	034	0	1	01	01	H5425_034_0	6	Select Care Drugs	4	000010	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5425	037	0	1	01	01	H5425_037_0	7	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	27.00					0.00	0.00	0.00					0.00	0.00	0.00																9.00				9.00			0.30	0.00	0.00			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	037	0	1	01	01	H5425_037_0	7	Generic	4	010000	1	1	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											6.86	25	25	25				6.86	25	25	25				25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	037	0	1	01	01	H5425_037_0	7	Preferred Brand	4	010001	1	1	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											64.23	25	25	25				64.23	25	25	25				25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	037	0	1	01	01	H5425_037_0	7	Non-Preferred Drug	4	100100	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											87.92	25	25	25				87.92	25	25	25				25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	037	0	1	01	01	H5425_037_0	7	Specialty Tier	4	010010	1	1	5	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												
H5425	037	0	1	01	01	H5425_037_0	7	Select Care Drugs	4	000010	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				11.00			0.37	0.37	0.37			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	040	0	1	01	01	H5425_040_0	7	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	24.00					0.00	0.00	0.00					0.00	0.00	0.00																8.00				8.00			0.27	0.00	0.00			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	040	0	1	01	01	H5425_040_0	7	Generic	4	010000	1	1	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											6.89	25	25	25				6.89	25	25	25				25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	040	0	1	01	01	H5425_040_0	7	Preferred Brand	4	010001	1	1	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											65.49	25	25	25				65.49	25	25	25				25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	040	0	1	01	01	H5425_040_0	7	Non-Preferred Drug	4	100100	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											88.66	25	25	25				88.66	25	25	25				25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	040	0	1	01	01	H5425_040_0	7	Specialty Tier	4	010010	1	1	5	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												
H5425	040	0	1	01	01	H5425_040_0	7	Select Care Drugs	4	000010	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				11.00			0.37	0.37	0.37			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	045	0	1	01	01	H5425_045_0	7	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	27.00					0.00	0.00	0.00					0.00	0.00	0.00																9.00				9.00			0.30	0.00	0.00			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	045	0	1	01	01	H5425_045_0	7	Generic	4	010000	1	1	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											6.75	25	25	25				6.75	25	25	25				25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	045	0	1	01	01	H5425_045_0	7	Preferred Brand	4	010001	1	1	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											64.67	25	25	25				64.67	25	25	25				25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	045	0	1	01	01	H5425_045_0	7	Non-Preferred Drug	4	100100	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											86.55	25	25	25				86.55	25	25	25				25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	045	0	1	01	01	H5425_045_0	7	Specialty Tier	4	010010	1	1	5	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												
H5425	045	0	1	01	01	H5425_045_0	7	Select Care Drugs	4	000010	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				11.00			0.37	0.37	0.37			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	046	0	1	01	01	H5425_046_0	6	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								3.00	6.00	6.00					0.00	0.00	0.00					0.00	0.00	0.00																3.00				3.00			0.10	0.00	0.00			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	046	0	1	01	01	H5425_046_0	6	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	14.00					2.00	4.00	4.00					2.00	4.00	4.00																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												
H5425	046	0	1	01	01	H5425_046_0	6	Preferred Brand	4	010001	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								45.00	90.00	125.00					40.00	80.00	110.00					40.00	80.00	110.00																45.00				45.00			1.50	1.33	1.33			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	046	0	1	01	01	H5425_046_0	6	Non-Preferred Drug	4	100100	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								85.00	170.00	245.00					80.00	160.00	230.00					80.00	160.00	230.00																85.00				85.00			2.83	2.67	2.67			2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	046	0	1	01	01	H5425_046_0	6	Specialty Tier	4	010010	1	1	5	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												
H5425	046	0	1	01	01	H5425_046_0	6	Select Care Drugs	4	000010	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								11.00	22.00	23.00					11.00	22.00	23.00					11.00	22.00	23.00																11.00				11.00			0.37	0.37	0.37			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	047	0	1	01	01	H5425_047_0	6	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								3.00	6.00	6.00					0.00	0.00	0.00					0.00	0.00	0.00																3.00				3.00			0.10	0.00	0.00			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	047	0	1	01	01	H5425_047_0	6	Preferred Generic	4	001000	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								3.00	6.00	6.00					0.00	0.00	0.00					0.00	0.00	0.00																3.00				3.00			0.10	0.00	0.00			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5425	047	0	1	01	01	H5425_047_0	6	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	14.00					2.00	4.00	4.00					2.00	4.00	4.00																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												
H5425	047	0	1	01	01	H5425_047_0	6	Generic	4	010000	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	14.00					2.00	4.00	4.00					2.00	4.00	4.00																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										1		
H5425	047	0	1	01	01	H5425_047_0	6	Preferred Brand	4	010001	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								45.00	90.00	125.00					40.00	80.00	110.00					40.00	80.00	110.00																45.00				45.00			1.50	1.33	1.33			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	047	0	1	01	01	H5425_047_0	6	Non-Preferred Drug	4	100100	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								95.00	190.00	275.00					90.00	180.00	260.00					90.00	180.00	260.00																95.00				95.00			3.17	3.00	3.00			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	047	0	1	01	01	H5425_047_0	6	Specialty Tier	4	010010	1	1	5	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												
H5425	047	0	1	01	01	H5425_047_0	6	Select Care Drugs	4	000010	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	047	0	1	01	01	H5425_047_0	6	Select Care Drugs	4	000010	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5425	048	0	1	01	01	H5425_048_0	6	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								3.00	6.00	6.00					0.00	0.00	0.00					0.00	0.00	0.00																3.00				3.00			0.10	0.00	0.00			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	048	0	1	01	01	H5425_048_0	6	Preferred Generic	4	001000	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								3.00	6.00	6.00					0.00	0.00	0.00					0.00	0.00	0.00																3.00				3.00			0.10	0.00	0.00			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5425	048	0	1	01	01	H5425_048_0	6	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	14.00					2.00	4.00	4.00					2.00	4.00	4.00																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												
H5425	048	0	1	01	01	H5425_048_0	6	Generic	4	010000	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	14.00					2.00	4.00	4.00					2.00	4.00	4.00																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										1		
H5425	048	0	1	01	01	H5425_048_0	6	Preferred Brand	4	010001	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								45.00	90.00	125.00					40.00	80.00	110.00					40.00	80.00	110.00																45.00				45.00			1.50	1.33	1.33			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	048	0	1	01	01	H5425_048_0	6	Non-Preferred Drug	4	100100	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								95.00	190.00	275.00					90.00	180.00	260.00					90.00	180.00	260.00																95.00				95.00			3.17	3.00	3.00			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	048	0	1	01	01	H5425_048_0	6	Specialty Tier	4	010010	1	1	5	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												
H5425	048	0	1	01	01	H5425_048_0	6	Select Care Drugs	4	000010	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	048	0	1	01	01	H5425_048_0	6	Select Care Drugs	4	000010	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5425	052	0	1	01	01	H5425_052_0	6	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	10.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	052	0	1	01	01	H5425_052_0	6	Generic	4	010000	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					10.00	20.00	20.00																15.00				15.00			0.50	0.33	0.33			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	052	0	1	01	01	H5425_052_0	6	Preferred Brand	4	010001	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	131.00					42.00	84.00	116.00					42.00	84.00	116.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	052	0	1	01	01	H5425_052_0	6	Non-Preferred Drug	4	100100	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	290.00					95.00	190.00	275.00					95.00	190.00	275.00																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	052	0	1	01	01	H5425_052_0	6	Specialty Tier	4	010010	1	1	5	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												
H5425	052	0	1	01	01	H5425_052_0	6	Select Care Drugs	4	000010	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								11.00	22.00	23.00					11.00	22.00	23.00					11.00	22.00	23.00																11.00				11.00			0.37	0.37	0.37			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	053	0	1	01	01	H5425_053_0	6	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	10.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	053	0	1	01	01	H5425_053_0	6	Preferred Generic	4	001000	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	10.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5425	053	0	1	01	01	H5425_053_0	6	Generic	4	010000	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					10.00	20.00	20.00																15.00				15.00			0.50	0.33	0.33			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	053	0	1	01	01	H5425_053_0	6	Preferred Brand	4	010001	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	131.00					42.00	84.00	116.00					42.00	84.00	116.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	053	0	1	01	01	H5425_053_0	6	Non-Preferred Drug	4	100100	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	290.00					95.00	190.00	275.00					95.00	190.00	275.00																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	053	0	1	01	01	H5425_053_0	6	Specialty Tier	4	010010	1	1	5	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												
H5425	053	0	1	01	01	H5425_053_0	6	Select Care Drugs	4	000010	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	053	0	1	01	01	H5425_053_0	6	Select Care Drugs	4	000010	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5425	054	0	1	01	01	H5425_054_0	6	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	10.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	054	0	1	01	01	H5425_054_0	6	Preferred Generic	4	001000	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	10.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5425	054	0	1	01	01	H5425_054_0	6	Generic	4	010000	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					10.00	20.00	20.00																15.00				15.00			0.50	0.33	0.33			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	054	0	1	01	01	H5425_054_0	6	Preferred Brand	4	010001	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	131.00					42.00	84.00	116.00					42.00	84.00	116.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	054	0	1	01	01	H5425_054_0	6	Non-Preferred Drug	4	100100	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	290.00					95.00	190.00	275.00					95.00	190.00	275.00																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	054	0	1	01	01	H5425_054_0	6	Specialty Tier	4	010010	1	1	5	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												
H5425	054	0	1	01	01	H5425_054_0	6	Select Care Drugs	4	000010	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	054	0	1	01	01	H5425_054_0	6	Select Care Drugs	4	000010	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5425	055	0	1	01	01	H5425_055_0	6	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	10.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	055	0	1	01	01	H5425_055_0	6	Preferred Generic	4	001000	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								5.00	10.00	10.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5425	055	0	1	01	01	H5425_055_0	6	Generic	4	010000	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					5.00	10.00	10.00																10.00				10.00			0.33	0.17	0.17			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	055	0	1	01	01	H5425_055_0	6	Preferred Brand	4	010001	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	131.00					42.00	84.00	116.00					42.00	84.00	116.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	055	0	1	01	01	H5425_055_0	6	Non-Preferred Drug	4	100100	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	290.00					95.00	190.00	275.00					95.00	190.00	275.00																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	055	0	1	01	01	H5425_055_0	6	Specialty Tier	4	010010	1	1	5	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												
H5425	055	0	1	01	01	H5425_055_0	6	Select Care Drugs	4	000010	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	055	0	1	01	01	H5425_055_0	6	Select Care Drugs	4	000010	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5425	056	0	1	01	01	H5425_056_0	6	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	14.00					0.00	0.00	0.00					0.00	0.00	0.00																7.00				7.00			0.23	0.00	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	056	0	1	01	01	H5425_056_0	6	Preferred Generic	4	001000	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	14.00					0.00	0.00	0.00					0.00	0.00	0.00																7.00				7.00			0.23	0.00	0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5425	056	0	1	01	01	H5425_056_0	6	Generic	4	010000	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					5.00	10.00	10.00																10.00				10.00			0.33	0.17	0.17			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	056	0	1	01	01	H5425_056_0	6	Preferred Brand	4	010001	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	131.00					42.00	84.00	116.00					42.00	84.00	116.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	056	0	1	01	01	H5425_056_0	6	Non-Preferred Drug	4	100100	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	290.00					95.00	190.00	275.00					95.00	190.00	275.00																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	056	0	1	01	01	H5425_056_0	6	Specialty Tier	4	010010	1	1	5	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												
H5425	056	0	1	01	01	H5425_056_0	6	Select Care Drugs	4	000010	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								11.00	22.00	23.00					11.00	22.00	23.00					11.00	22.00	23.00																11.00				11.00			0.37	0.37	0.37			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	057	0	1	01	01	H5425_057_0	5	Preferred Generic	4	001000	1	2	1	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					0.00	0.00	0.00																11.00				11.00			0.37	0.00	0.00			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	057	0	1	01	01	H5425_057_0	5	Generic	4	010000	1	1	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											6.31	25	25	25				6.31	25	25	25				25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	057	0	1	01	01	H5425_057_0	5	Preferred Brand	4	010001	1	1	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											67.59	25	25	25				67.59	25	25	25				25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	057	0	1	01	01	H5425_057_0	5	Non-Preferred Drug	4	100100	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											55.64	25	25	25				55.64	25	25	25				25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	057	0	1	01	01	H5425_057_0	5	Specialty Tier	4	010010	1	1	5	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												
H5425	057	0	1	01	01	H5425_057_0	5	Select Care Drugs	4	000010	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				11.00			0.37	0.37	0.37			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	061	0	1	01	01	H5425_061_0	6	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	14.00					2.00	4.00	4.00					2.00	4.00	4.00																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												
H5425	061	0	1	01	01	H5425_061_0	6	Preferred Generic	4	001000	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	14.00					2.00	4.00	4.00					2.00	4.00	4.00																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										1		
H5425	061	0	1	01	01	H5425_061_0	6	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	24.00					7.00	14.00	14.00					7.00	14.00	14.00																12.00				12.00			0.40	0.23	0.23			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	061	0	1	01	01	H5425_061_0	6	Preferred Brand	4	010001	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	131.00					42.00	84.00	116.00					42.00	84.00	116.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	061	0	1	01	01	H5425_061_0	6	Non-Preferred Drug	4	100100	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	290.00					95.00	190.00	275.00					95.00	190.00	275.00																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	061	0	1	01	01	H5425_061_0	6	Specialty Tier	4	010010	1	1	5	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												
H5425	061	0	1	01	01	H5425_061_0	6	Select Care Drugs	4	000010	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								11.00	22.00	23.00					11.00	22.00	23.00					11.00	22.00	23.00																11.00				11.00			0.37	0.37	0.37			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	062	0	1	01	01	H5425_062_0	6	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	14.00					2.00	4.00	4.00					2.00	4.00	4.00																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												
H5425	062	0	1	01	01	H5425_062_0	6	Preferred Generic	4	001000	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	14.00					2.00	4.00	4.00					2.00	4.00	4.00																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										1		
H5425	062	0	1	01	01	H5425_062_0	6	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	24.00					7.00	14.00	14.00					7.00	14.00	14.00																12.00				12.00			0.40	0.23	0.23			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	062	0	1	01	01	H5425_062_0	6	Preferred Brand	4	010001	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	131.00					42.00	84.00	116.00					42.00	84.00	116.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	062	0	1	01	01	H5425_062_0	6	Non-Preferred Drug	4	100100	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	290.00					95.00	190.00	275.00					95.00	190.00	275.00																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	062	0	1	01	01	H5425_062_0	6	Specialty Tier	4	010010	1	1	5	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												
H5425	062	0	1	01	01	H5425_062_0	6	Select Care Drugs	4	000010	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								11.00	22.00	23.00					11.00	22.00	23.00					11.00	22.00	23.00																11.00				11.00			0.37	0.37	0.37			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	064	0	1	01	01	H5425_064_0	6	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	064	0	1	01	01	H5425_064_0	6	Preferred Generic	4	001000	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, Select Care Drugs										1		
H5425	064	0	1	01	01	H5425_064_0	6	Generic	4	010000	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					5.00	10.00	10.00																10.00				10.00			0.33	0.17	0.17			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	064	0	1	01	01	H5425_064_0	6	Generic	4	010000	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	20.00					5.00	10.00	10.00					5.00	10.00	10.00																10.00				10.00			0.33	0.17	0.17			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5425	064	0	1	01	01	H5425_064_0	6	Preferred Brand	4	010001	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	131.00					42.00	84.00	116.00					42.00	84.00	116.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	064	0	1	01	01	H5425_064_0	6	Non-Preferred Drug	4	100100	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	290.00					95.00	190.00	275.00					95.00	190.00	275.00																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5425	064	0	1	01	01	H5425_064_0	6	Specialty Tier	4	010010	1	1	5	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												
H5425	064	0	1	01	01	H5425_064_0	6	Select Care Drugs	4	000010	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								11.00	22.00	23.00					11.00	22.00	23.00					11.00	22.00	23.00																11.00				11.00			0.37	0.37	0.37			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5427	059	0	1	01	01	H5427_059_0	10	Preferred Generic	4	001000	3	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	059	0	1	01	01	H5427_059_0	10	Preferred Generic	4	001000	3	2	1	3	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5427	059	0	1	01	01	H5427_059_0	10	Preferred Brand	4	000101	1	2	2	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, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	059	0	1	01	01	H5427_059_0	10	Non-Preferred Drug	4	100100	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	95.00		285.00																			95.00		190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	059	0	1	01	01	H5427_059_0	10	Specialty Tier	4	100100	1	1	4	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	060	0	1	01	01	H5427_060_0	9	Preferred Generic	4	001000	3	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	060	0	1	01	01	H5427_060_0	9	Preferred Generic	4	001000	3	2	1	3	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5427	060	0	1	01	01	H5427_060_0	9	Preferred Brand	4	000101	1	2	2	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, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	060	0	1	01	01	H5427_060_0	9	Non-Preferred Drug	4	100100	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	85.00		255.00																			85.00		170.00																85.00				85.00		2.83			2.83			2.74	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	060	0	1	01	01	H5427_060_0	9	Specialty Tier	4	100100	1	1	4	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	070	0	1	01	01	H5427_070_0	7	Preferred Generic	4	001000	3	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5427	070	0	1	01	01	H5427_070_0	7	Preferred Generic	4	001000	3	2	1	3	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs										1		3
H5427	070	0	1	01	01	H5427_070_0	7	Preferred Brand	4	000101	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	25.00		75.00																			25.00		50.00																25.00				25.00		0.83			0.83			0.81	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5427	070	0	1	01	01	H5427_070_0	7	Non-Preferred Drug	4	100100	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	75.00		225.00																			75.00		150.00																75.00				75.00		2.50			2.50			2.42	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5427	070	0	1	01	01	H5427_070_0	7	Specialty Tier	4	100100	1	1	4	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5427	070	0	1	01	01	H5427_070_0	7	Select Diabetic Drugs	4	000010	1	2	5	1	110		01	110		1	30		90				1	2	30		90				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5427	070	0	1	01	01	H5427_070_0	7	Select Diabetic Drugs	4	000010	1	2	5	3	110		01	110		1	30		90				1	2	30		90				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs										1		
H5427	072	0	1	01	01	H5427_072_0	8	Preferred Generic	4	001000	3	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5427	072	0	1	01	01	H5427_072_0	8	Preferred Generic	4	001000	3	2	1	3	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs										1		3
H5427	072	0	1	01	01	H5427_072_0	8	Preferred Brand	4	000101	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	35.00		105.00																			35.00		70.00																35.00				35.00		1.17			1.17			1.13	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5427	072	0	1	01	01	H5427_072_0	8	Non-Preferred Drug	4	100100	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	80.00		240.00																			80.00		160.00																80.00				80.00		2.67			2.67			2.58	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5427	072	0	1	01	01	H5427_072_0	8	Specialty Tier	4	100100	1	1	4	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5427	072	0	1	01	01	H5427_072_0	8	Select Diabetic Drugs	4	000010	1	2	5	1	110		01	110		1	30		90				1	2	30		90				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5427	077	0	1	01	01	H5427_077_0	7	Preferred Generic	4	001000	3	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	077	0	1	01	01	H5427_077_0	7	Preferred Generic	4	001000	3	2	1	3	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5427	077	0	1	01	01	H5427_077_0	7	Preferred Brand	4	000101	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	35.00		105.00																			35.00		70.00																35.00				35.00		1.17			1.17			1.13	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	077	0	1	01	01	H5427_077_0	7	Non-Preferred Drug	4	100100	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	80.00		240.00																			80.00		160.00																80.00				80.00		2.67			2.67			2.58	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	077	0	1	01	01	H5427_077_0	7	Specialty Tier	4	100100	1	1	4	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	082	0	1	01	01	H5427_082_0	8	Preferred Generic	4	001000	3	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5427	082	0	1	01	01	H5427_082_0	8	Preferred Generic	4	001000	3	2	1	3	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs										1		3
H5427	082	0	1	01	01	H5427_082_0	8	Preferred Brand	4	000101	1	2	2	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, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5427	082	0	1	01	01	H5427_082_0	8	Non-Preferred Drug	4	100100	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	90.00		270.00																			90.00		180.00																90.00				90.00		3.00			3.00			2.90	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5427	082	0	1	01	01	H5427_082_0	8	Specialty Tier	4	100100	1	1	4	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5427	082	0	1	01	01	H5427_082_0	8	Select Diabetic Drugs	4	000010	1	2	5	1	110		01	110		1	30		90				1	2	30		90				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5427	083	0	1	01	01	H5427_083_0	9	Preferred Generic	4	001000	3	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	083	0	1	01	01	H5427_083_0	9	Preferred Generic	4	001000	3	2	1	3	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5427	083	0	1	01	01	H5427_083_0	9	Preferred Brand	4	000101	1	2	2	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, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	083	0	1	01	01	H5427_083_0	9	Non-Preferred Drug	4	100100	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	90.00		270.00																			90.00		180.00																90.00				90.00		3.00			3.00			2.90	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	083	0	1	01	01	H5427_083_0	9	Specialty Tier	4	100100	1	1	4	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	087	0	1	01	01	H5427_087_0	7	Preferred Generic	4	001000	3	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	087	0	1	01	01	H5427_087_0	7	Preferred Brand	4	000101	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	45.00		135.00																			45.00		135.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	087	0	1	01	01	H5427_087_0	7	Non-Preferred Drug	4	100100	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	95.00		285.00																			95.00		285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	087	0	1	01	01	H5427_087_0	7	Specialty Tier	4	100100	1	1	4	1	010		01	010		1	30								30						30		31					25																				25																	25			25								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	088	0	1	01	01	H5427_088_0	8	Preferred Generic	4	001000	3	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	088	0	1	01	01	H5427_088_0	8	Preferred Generic	4	001000	3	2	1	3	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5427	088	0	1	01	01	H5427_088_0	8	Preferred Brand	4	000101	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	30.00		90.00																			30.00		60.00																30.00				30.00		1.00			1.00			0.97	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	088	0	1	01	01	H5427_088_0	8	Non-Preferred Drug	4	100100	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	95.00		285.00																			95.00		190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	088	0	1	01	01	H5427_088_0	8	Specialty Tier	4	100100	1	1	4	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	089	0	1	01	01	H5427_089_0	8	Preferred Generic	4	001000	3	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	089	0	1	01	01	H5427_089_0	8	Preferred Generic	4	001000	3	2	1	3	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5427	089	0	1	01	01	H5427_089_0	8	Preferred Brand	4	000101	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	35.00		105.00																			35.00		70.00																35.00				35.00		1.17			1.17			1.13	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	089	0	1	01	01	H5427_089_0	8	Non-Preferred Drug	4	100100	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	80.00		240.00																			80.00		160.00																80.00				80.00		2.67			2.67			2.58	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	089	0	1	01	01	H5427_089_0	8	Specialty Tier	4	100100	1	1	4	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	091	0	1	01	01	H5427_091_0	8	Preferred Generic	4	001000	3	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	091	0	1	01	01	H5427_091_0	8	Preferred Generic	4	001000	3	2	1	3	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5427	091	0	1	01	01	H5427_091_0	8	Preferred Brand	4	000101	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	35.00		105.00																			35.00		70.00																35.00				35.00		1.17			1.17			1.13	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	091	0	1	01	01	H5427_091_0	8	Non-Preferred Drug	4	100100	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	80.00		240.00																			80.00		160.00																80.00				80.00		2.67			2.67			2.58	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	091	0	1	01	01	H5427_091_0	8	Specialty Tier	4	100100	1	1	4	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	092	0	1	01	01	H5427_092_0	8	Preferred Generic	4	001000	3	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	092	0	1	01	01	H5427_092_0	8	Preferred Generic	4	001000	3	2	1	3	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5427	092	0	1	01	01	H5427_092_0	8	Preferred Brand	4	000101	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	30.00		90.00																			30.00		60.00																30.00				30.00		1.00			1.00			0.97	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	092	0	1	01	01	H5427_092_0	8	Non-Preferred Drug	4	100100	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	69.00		207.00																			69.00		138.00																69.00				69.00		2.30			2.30			2.23	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	092	0	1	01	01	H5427_092_0	8	Specialty Tier	4	100100	1	1	4	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	093	0	1	01	01	H5427_093_0	8	Preferred Generic	4	001000	3	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	093	0	1	01	01	H5427_093_0	8	Preferred Generic	4	001000	3	2	1	3	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5427	093	0	1	01	01	H5427_093_0	8	Preferred Brand	4	000101	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	30.00		90.00																			30.00		60.00																30.00				30.00		1.00			1.00			0.97	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	093	0	1	01	01	H5427_093_0	8	Non-Preferred Drug	4	100100	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	69.00		207.00																			69.00		138.00																69.00				69.00		2.30			2.30			2.23	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	093	0	1	01	01	H5427_093_0	8	Specialty Tier	4	100100	1	1	4	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	094	0	1	01	01	H5427_094_0	8	Preferred Generic	4	001000	3	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	094	0	1	01	01	H5427_094_0	8	Preferred Generic	4	001000	3	2	1	3	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5427	094	0	1	01	01	H5427_094_0	8	Preferred Brand	4	000101	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	30.00		90.00																			30.00		60.00																30.00				30.00		1.00			1.00			0.97	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	094	0	1	01	01	H5427_094_0	8	Non-Preferred Drug	4	100100	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	80.00		240.00																			80.00		160.00																80.00				80.00		2.67			2.67			2.58	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5427	094	0	1	01	01	H5427_094_0	8	Specialty Tier	4	100100	1	1	4	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5430	001	0	1	01	01	H5430_001_0	4	Preferred Generic	4	001000	1	1	1	1		110	01			1				30		90	2	2							30		31											1.43	25		25				0.00	0		0																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5430	001	0	1	01	01	H5430_001_0	4	Generic	4	010000	1	1	2	1		110	01			1				30		90	2	2							30		31											6.92	25		25				6.92	25		25																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5430	001	0	1	01	01	H5430_001_0	4	Preferred Brand	4	000001	1	1	3	1		110	01			1				30		90	2	2							30		31											57.79	25		25				57.79	25		25																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5430	001	0	1	01	01	H5430_001_0	4	Non-Preferred Drug	4	100100	1	1	4	1		110	01			1				30		90	2	2							30		31											69.13	25		25				69.13	25		25																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5430	001	0	1	01	01	H5430_001_0	4	Specialty Tier	4	010010	1	1	5	1		110	01			1				30		90	2	2							30		31											893.56	25		25				893.56	25		25																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5431	001	0	1	01	01	H5431_001_0	10	Preferred Generic	4	001000	1	2	1	1		110	01			1				30		90	2	2							30		31								0.00		0.00					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 Brand and Generic Drugs												
H5431	001	0	1	01	01	H5431_001_0	10	Preferred Generic	4	001000	1	2	1	3		110	01			1				30		90	2	2							30		31								0.00		0.00					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 Brand and Generic Drugs										1		
H5431	001	0	1	01	01	H5431_001_0	10	Generic	4	010000	1	2	2	1		110	01			1				30		90	2	2							30		31								10.00		20.00					0.00		0.00																							10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Brand and Generic Drugs												
H5431	001	0	1	01	01	H5431_001_0	10	Generic	4	010000	1	2	2	3		110	01			1				30		90	2	2							30		31								10.00		20.00					0.00		0.00																							10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Brand and Generic Drugs										1		
H5431	001	0	1	01	01	H5431_001_0	10	Preferred Brand	4	000001	1	2	3	1		010	01			1				30											30		31								25.00							15.00																									15.00				15.00			0.83	0.50				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Brand and Generic Drugs												
H5431	001	0	1	01	01	H5431_001_0	10	Non-Preferred Drug	4	100000	1	2	4	1		010	01			1				30											30		31								50.00							25.00																									50.00				25.00			1.67	0.83				0.81	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Brand and Generic Drugs												
H5431	001	0	1	01	01	H5431_001_0	10	Specialty Tier	4	010010	1	1	5	1		010	01			1				30											30		31											1475.04	33						753.68	33																							33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Brand and Generic Drugs												
H5431	001	0	1	01	01	H5431_001_0	10	Supplemental Brand and Generic Drugs	4	010010	2	2	6	1		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Brand and Generic Drugs												
H5431	006	0	1	01	01	H5431_006_0	10	Preferred Generic	4	001000	1	1	1	1	110		01			1	30		90				2	2							30		31				2.75	25		25																																			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Brand and Generic Drugs												
H5431	006	0	1	01	01	H5431_006_0	10	Generic	4	010000	1	1	2	1	110		01			1	30		90				2	2							30		31				27.17	25		25																																			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Brand and Generic Drugs												
H5431	006	0	1	01	01	H5431_006_0	10	Preferred Brand	4	000001	1	1	3	1	010		01			1	30														30		31				63.49	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Brand and Generic Drugs												
H5431	006	0	1	01	01	H5431_006_0	10	Non-Preferred Drug	4	100000	1	1	4	1	010		01			1	30														30		31				57.52	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Brand and Generic Drugs												
H5431	006	0	1	01	01	H5431_006_0	10	Specialty Tier	4	010010	1	1	5	1	010		01			1	30														30		31				577.31	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Brand and Generic Drugs												
H5431	006	0	1	01	01	H5431_006_0	10	Supplemental Brand and Generic Drugs	4	010010	2	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Brand and Generic Drugs												
H5431	006	0	1	01	01	H5431_006_0	10	Supplemental Brand and Generic Drugs	4	010010	2	2	6	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, Supplemental Brand and Generic Drugs										1		
H5431	012	0	1	01	01	H5431_012_0	11	Preferred Generic	4	001000	1	2	1	1		110	01			1				30		90	2	2							30		31								0.00		0.00					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 Brand and Generic Drugs												
H5431	012	0	1	01	01	H5431_012_0	11	Preferred Generic	4	001000	1	2	1	3		110	01			1				30		90	2	2							30		31								0.00		0.00					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 Brand and Generic Drugs										1		
H5431	012	0	1	01	01	H5431_012_0	11	Generic	4	010000	1	2	2	1		110	01			1				30		90	2	2							30		31								10.00		20.00					0.00		0.00																							10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Brand and Generic Drugs												
H5431	012	0	1	01	01	H5431_012_0	11	Generic	4	010000	1	2	2	3		110	01			1				30		90	2	2							30		31								10.00		20.00					0.00		0.00																							10.00				10.00			0.33	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Brand and Generic Drugs										1		
H5431	012	0	1	01	01	H5431_012_0	11	Preferred Brand	4	000001	1	2	3	1		010	01			1				30											30		31								25.00							15.00																									25.00				25.00			0.83	0.50				0.81	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Brand and Generic Drugs												
H5431	012	0	1	01	01	H5431_012_0	11	Non-Preferred Drug	4	100000	1	2	4	1		010	01			1				30											30		31								50.00							30.00																									50.00				50.00			1.67	1.00				1.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Brand and Generic Drugs												
H5431	012	0	1	01	01	H5431_012_0	11	Specialty Tier	4	010010	1	1	5	1		010	01			1				30											30		31											823.78	33						616.37	33																							33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Brand and Generic Drugs												
H5431	012	0	1	01	01	H5431_012_0	11	Supplemental Brand and Generic Drugs	4	010010	2	2	6	1		010	01			1				30											30		31								0.00							0.00																									0.00				0.00			0.00	0.00				0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Supplemental Brand and Generic Drugs												
H5433	001	0	1	01	01	H5433_001_0	8	Generic	4	010010	1	2	1	1	010		01			1	30														30		31	0.00																																							0.00				0.00									Generic, Brand												
H5433	001	0	1	01	01	H5433_001_0	8	Generic	4	010010	1	2	1	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Generic, Brand										1		
H5433	001	0	1	01	01	H5433_001_0	8	Brand	4	000010	1	2	2	1	010		01			1	30														30		31	0.00																																							0.00				0.00									Generic, Brand												
H5434	002	0	1	04	01	H5434_002_0	8	Preferred Generic	3	001000	1	2	1	1		110	01	110		1				31		90	1	1	31		90				31		31								19.00		57.00					12.00		36.00					12.00		36.00																19.00				12.00			0.61	0.39	0.39			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5434	002	0	1	04	01	H5434_002_0	8	Generic	3	010000	1	2	2	1		110	01	110		1				31		90	1	1	31		90				31		31								20.00		60.00					13.00		39.00					13.00		39.00																20.00				13.00			0.65	0.42	0.42			0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5434	002	0	1	04	01	H5434_002_0	8	Preferred Brand	3	010001	1	2	3	1		110	01	110		1				31		90	1	1	31		90				31		31								47.00		141.00					40.00		120.00					40.00		120.00																47.00				40.00			1.52	1.29	1.29			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5434	002	0	1	04	01	H5434_002_0	8	Non-Preferred Brand	3	110000	1	2	4	1		110	01	110		1				31		90	1	1	31		90				31		31								100.00		300.00					93.00		279.00					93.00		279.00																100.00				93.00			3.23	3.00	3.00			3.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5434	002	0	1	04	01	H5434_002_0	8	Specialty Tier	3	010010	1	1	5	1		010	01	010		1				31					31						31		31											513.87	26						513.87	26						26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5435	024	0	1	09	04	H5435_024_0	4	Preferred Generic	3	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5435	024	0	1	09	04	H5435_024_0	4	Generic	3	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5435	024	0	1	09	04	H5435_024_0	4	Preferred Brand	3	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		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	4	Non-Preferred Drug	3	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		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	4	Specialty Tier	3	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				835.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5441	001	0	1	48	05	H5441_001_0	8	Generic Drugs	4	010000			1	1	110		01	100		1	30		90				1	2			90				30		31																																														0.00						0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H5441	001	0	1	48	05	H5441_001_0	8	Brand Drugs	4	000010			2	1	110		01	100		1	30		90				1	2			90				30		31																																														0.00						0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H5441	001	0	1	48	05	H5441_001_0	8	Non-Medicare Rx/OTC Drugs	4	010010			3	1	010		01			1	30														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			
H5471	001	0	1	01	01	H5471_001_0	9	Preferred Generic	4	001000	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	001	0	1	01	01	H5471_001_0	9	Preferred Generic	4	001000	3	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5471	001	0	1	01	01	H5471_001_0	9	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	001	0	1	01	01	H5471_001_0	9	Generic	4	010000	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	001	0	1	01	01	H5471_001_0	9	Preferred Brand	4	000001	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								45.00	90.00	135.00					45.00	90.00	135.00					45.00	135.00	135.00																45.00				45.00			1.50	1.50	1.50			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	001	0	1	01	01	H5471_001_0	9	Non-Preferred Brand	4	100000	1	2	4	1		010	01	010		1				30					30						30		34								80.00							75.00							75.00																		80.00				80.00			2.67	2.50	2.50			2.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	001	0	1	01	01	H5471_001_0	9	Specialty Tier	4	010010	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	002	0	1	01	01	H5471_002_0	8	Preferred Generic	4	001000	3	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	002	0	1	01	01	H5471_002_0	8	Preferred Generic	4	001000	3	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5471	002	0	1	01	01	H5471_002_0	8	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	002	0	1	01	01	H5471_002_0	8	Generic	4	010000	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	002	0	1	01	01	H5471_002_0	8	Preferred Brand	4	000001	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	002	0	1	01	01	H5471_002_0	8	Non-Preferred Brand	4	100000	1	2	4	1	010		01	010		1	30								30						30		34	20.00																					20.00																		20.00				20.00		0.67			0.67			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	002	0	1	01	01	H5471_002_0	8	Specialty Tier	4	010010	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	007	0	1	01	01	H5471_007_0	8	Preferred Generic	4	001000	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	007	0	1	01	01	H5471_007_0	8	Preferred Generic	4	001000	3	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5471	007	0	1	01	01	H5471_007_0	8	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	007	0	1	01	01	H5471_007_0	8	Generic	4	010000	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	007	0	1	01	01	H5471_007_0	8	Preferred Brand	4	000001	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								45.00	90.00	135.00					45.00	90.00	135.00					45.00	135.00	135.00																45.00				45.00			1.50	1.50	1.50			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	007	0	1	01	01	H5471_007_0	8	Non-Preferred Brand	4	100000	1	2	4	1		010	01	010		1				30					30						30		34								95.00							90.00							90.00																		95.00				95.00			3.17	3.00	3.00			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	007	0	1	01	01	H5471_007_0	8	Specialty Tier	4	010010	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	008	0	1	01	01	H5471_008_0	7	Preferred Generic	4	001000	1	2	1	1	111		01			1	30	60	90				1	2							30		34	5.00	10.00	15.00																																					5.00				5.00		0.17						0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	008	0	1	01	01	H5471_008_0	7	Preferred Generic	4	001000	1	2	1	3	111		01			1	30	60	90				1	2							30		34	5.00	10.00	15.00																																					5.00				5.00		0.17						0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	008	0	1	01	01	H5471_008_0	7	Generic	4	010000	1	2	2	1	111		01			1	30	60	90				1	2							30		34	10.00	20.00	30.00																																					10.00				10.00		0.33						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	008	0	1	01	01	H5471_008_0	7	Generic	4	010000	1	2	2	3	111		01			1	30	60	90				1	2							30		34	10.00	20.00	30.00																																					10.00				10.00		0.33						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	008	0	1	01	01	H5471_008_0	7	Preferred Brand	4	000001	1	2	3	1	111		01			1	30	60	90				1	2							30		34	15.00	30.00	45.00																																					15.00				15.00		0.50						0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	008	0	1	01	01	H5471_008_0	7	Non-Preferred Brand	4	100000	1	2	4	1	010		01			1	30														30		34	35.00																																							35.00				35.00		1.17						1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	008	0	1	01	01	H5471_008_0	7	Specialty Tier	4	010010	1	1	5	1	010		01			1	30														30		34					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	009	0	1	01	01	H5471_009_0	8	Preferred Generic	4	001000	3	2	1	1	111		01			1	30	60	90				1	2							30		34	5.00	10.00	15.00																																					5.00				5.00		0.17						0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	009	0	1	01	01	H5471_009_0	8	Preferred Generic	4	001000	3	2	1	3	111		01			1	30	60	90				1	2							30		34	5.00	10.00	15.00																																					5.00				5.00		0.17						0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5471	009	0	1	01	01	H5471_009_0	8	Generic	4	010000	1	2	2	1	111		01			1	30	60	90				1	2							30		34	10.00	20.00	30.00																																					10.00				10.00		0.33						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	009	0	1	01	01	H5471_009_0	8	Generic	4	010000	1	2	2	3	111		01			1	30	60	90				1	2							30		34	10.00	20.00	30.00																																					10.00				10.00		0.33						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	009	0	1	01	01	H5471_009_0	8	Preferred Brand	4	000001	1	2	3	1	111		01			1	30	60	90				1	2							30		34	15.00	30.00	45.00																																					15.00				15.00		0.50						0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	009	0	1	01	01	H5471_009_0	8	Non-Preferred Brand	4	100000	1	2	4	1	010		01			1	30														30		34	35.00																																							35.00				35.00		1.17						1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	009	0	1	01	01	H5471_009_0	8	Specialty Tier	4	010010	1	1	5	1	010		01			1	30														30		34					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	012	0	1	01	01	H5471_012_0	8	Preferred Generic	4	001000	3	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	012	0	1	01	01	H5471_012_0	8	Preferred Generic	4	001000	3	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5471	012	0	1	01	01	H5471_012_0	8	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	012	0	1	01	01	H5471_012_0	8	Generic	4	010000	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	012	0	1	01	01	H5471_012_0	8	Preferred Brand	4	000001	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	012	0	1	01	01	H5471_012_0	8	Preferred Brand	4	000001	1	2	3	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H5471	012	0	1	01	01	H5471_012_0	8	Non-Preferred Brand	4	100000	1	2	4	1	010		01	010		1	30								30						30		34	15.00																					15.00																		15.00				15.00		0.50			0.50			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	012	0	1	01	01	H5471_012_0	8	Non-Preferred Brand	4	100000	1	2	4	3	010		01	010		1	30								30						30		34	15.00																					15.00																		15.00				15.00		0.50			0.50			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H5471	012	0	1	01	01	H5471_012_0	8	Specialty Tier	4	010010	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	020	0	1	01	01	H5471_020_0	9	Preferred Generic	4	001000	3	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	020	0	1	01	01	H5471_020_0	9	Preferred Generic	4	001000	3	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5471	020	0	1	01	01	H5471_020_0	9	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	020	0	1	01	01	H5471_020_0	9	Generic	4	010000	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	020	0	1	01	01	H5471_020_0	9	Preferred Brand	4	000001	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	020	0	1	01	01	H5471_020_0	9	Preferred Brand	4	000001	1	2	3	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H5471	020	0	1	01	01	H5471_020_0	9	Non-Preferred Brand	4	100000	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	020	0	1	01	01	H5471_020_0	9	Non-Preferred Brand	4	100000	1	2	4	3	010		01	010		1	30								30						30		34	55.00																					55.00																		55.00				55.00		1.83			1.83			1.62	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H5471	020	0	1	01	01	H5471_020_0	9	Specialty Tier	4	010010	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	021	0	1	01	01	H5471_021_0	9	Preferred Generic	4	001000	3	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	021	0	1	01	01	H5471_021_0	9	Preferred Generic	4	001000	3	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5471	021	0	1	01	01	H5471_021_0	9	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	021	0	1	01	01	H5471_021_0	9	Generic	4	010000	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	021	0	1	01	01	H5471_021_0	9	Preferred Brand	4	000001	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	15.00	30.00	45.00																			15.00	45.00	45.00																15.00				15.00		0.50			0.50			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	021	0	1	01	01	H5471_021_0	9	Non-Preferred Brand	4	100000	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	021	0	1	01	01	H5471_021_0	9	Specialty Tier	4	010010	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	039	0	1	01	01	H5471_039_0	8	Preferred Generic	4	001000	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	039	0	1	01	01	H5471_039_0	8	Preferred Generic	4	001000	3	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5471	039	0	1	01	01	H5471_039_0	8	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	039	0	1	01	01	H5471_039_0	8	Generic	4	010000	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	039	0	1	01	01	H5471_039_0	8	Preferred Brand	4	000001	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								45.00	90.00	135.00					45.00	90.00	135.00					45.00	135.00	135.00																45.00				45.00			1.50	1.50	1.50			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	039	0	1	01	01	H5471_039_0	8	Non-Preferred Brand	4	100000	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	039	0	1	01	01	H5471_039_0	8	Specialty Tier	4	010010	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	042	0	1	01	01	H5471_042_0	9	Preferred Generic	4	001000	3	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	042	0	1	01	01	H5471_042_0	9	Preferred Generic	4	001000	3	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5471	042	0	1	01	01	H5471_042_0	9	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	5.00	10.00	15.00																			5.00	15.00	15.00																5.00				5.00		0.17			0.17			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	042	0	1	01	01	H5471_042_0	9	Generic	4	010000	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	5.00	10.00	15.00																			5.00	15.00	15.00																5.00				5.00		0.17			0.17			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	042	0	1	01	01	H5471_042_0	9	Preferred Brand	4	000001	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	35.00	70.00	105.00																			35.00	105.00	105.00																35.00				35.00		1.17			1.17			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	042	0	1	01	01	H5471_042_0	9	Preferred Brand	4	000001	1	2	3	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	35.00	70.00	105.00																			35.00	105.00	105.00																35.00				35.00		1.17			1.17			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H5471	042	0	1	01	01	H5471_042_0	9	Non-Preferred Brand	4	100000	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	042	0	1	01	01	H5471_042_0	9	Non-Preferred Brand	4	100000	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	042	0	1	01	01	H5471_042_0	9	Specialty Tier	4	010010	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	043	0	1	01	01	H5471_043_0	9	Preferred Generic	4	001000	3	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	043	0	1	01	01	H5471_043_0	9	Preferred Generic	4	001000	3	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5471	043	0	1	01	01	H5471_043_0	9	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	5.00	10.00	15.00																			5.00	15.00	15.00																5.00				5.00		0.17			0.17			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	043	0	1	01	01	H5471_043_0	9	Generic	4	010000	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	5.00	10.00	15.00																			5.00	15.00	15.00																5.00				5.00		0.17			0.17			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	043	0	1	01	01	H5471_043_0	9	Preferred Brand	4	000001	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	35.00	70.00	105.00																			35.00	105.00	105.00																35.00				35.00		1.17			1.17			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	043	0	1	01	01	H5471_043_0	9	Non-Preferred Brand	4	100000	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	043	0	1	01	01	H5471_043_0	9	Specialty Tier	4	010010	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	049	0	1	01	01	H5471_049_0	9	Preferred Generic	4	001000	3	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	049	0	1	01	01	H5471_049_0	9	Preferred Generic	4	001000	3	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5471	049	0	1	01	01	H5471_049_0	9	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	5.00	10.00	15.00																			5.00	15.00	15.00																5.00				5.00		0.17			0.17			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	049	0	1	01	01	H5471_049_0	9	Generic	4	010000	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	5.00	10.00	15.00																			5.00	15.00	15.00																5.00				5.00		0.17			0.17			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	049	0	1	01	01	H5471_049_0	9	Preferred Brand	4	000001	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	35.00	70.00	105.00																			35.00	105.00	105.00																35.00				35.00		1.17			1.17			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	049	0	1	01	01	H5471_049_0	9	Preferred Brand	4	000001	1	2	3	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	35.00	70.00	105.00																			35.00	105.00	105.00																35.00				35.00		1.17			1.17			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H5471	049	0	1	01	01	H5471_049_0	9	Non-Preferred Brand	4	100000	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	049	0	1	01	01	H5471_049_0	9	Non-Preferred Brand	4	100000	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	049	0	1	01	01	H5471_049_0	9	Specialty Tier	4	010010	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	050	0	1	01	01	H5471_050_0	9	Preferred Generic	4	001000	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	050	0	1	01	01	H5471_050_0	9	Preferred Generic	4	001000	3	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5471	050	0	1	01	01	H5471_050_0	9	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	050	0	1	01	01	H5471_050_0	9	Generic	4	010000	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	050	0	1	01	01	H5471_050_0	9	Preferred Brand	4	000001	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								45.00	90.00	135.00					45.00	90.00	135.00					45.00	135.00	135.00																45.00				45.00			1.50	1.50	1.50			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	050	0	1	01	01	H5471_050_0	9	Non-Preferred Brand	4	100000	1	2	4	1		010	01	010		1				30					30						30		34								95.00							90.00							90.00																		95.00				95.00			3.17	3.00	3.00			2.79	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	050	0	1	01	01	H5471_050_0	9	Specialty Tier	4	010010	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	051	0	1	01	01	H5471_051_0	9	Preferred Generic	4	001000	3	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	051	0	1	01	01	H5471_051_0	9	Preferred Generic	4	001000	3	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5471	051	0	1	01	01	H5471_051_0	9	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	5.00	10.00	15.00																			5.00	15.00	15.00																5.00				5.00		0.17			0.17			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	051	0	1	01	01	H5471_051_0	9	Generic	4	010000	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	5.00	10.00	15.00																			5.00	15.00	15.00																5.00				5.00		0.17			0.17			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	051	0	1	01	01	H5471_051_0	9	Preferred Brand	4	000001	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	35.00	70.00	105.00																			35.00	105.00	105.00																35.00				35.00		1.17			1.17			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	051	0	1	01	01	H5471_051_0	9	Non-Preferred Brand	4	100000	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	051	0	1	01	01	H5471_051_0	9	Specialty Tier	4	010010	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	052	0	1	01	01	H5471_052_0	9	Preferred Generic	4	001000	3	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	052	0	1	01	01	H5471_052_0	9	Preferred Generic	4	001000	3	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5471	052	0	1	01	01	H5471_052_0	9	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	5.00	10.00	15.00																			5.00	15.00	15.00																5.00				5.00		0.17			0.17			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	052	0	1	01	01	H5471_052_0	9	Generic	4	010000	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	5.00	10.00	15.00																			5.00	15.00	15.00																5.00				5.00		0.17			0.17			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	052	0	1	01	01	H5471_052_0	9	Preferred Brand	4	000001	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	35.00	70.00	105.00																			35.00	105.00	105.00																35.00				35.00		1.17			1.17			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	052	0	1	01	01	H5471_052_0	9	Non-Preferred Brand	4	100000	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	052	0	1	01	01	H5471_052_0	9	Specialty Tier	4	010010	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	053	0	1	01	01	H5471_053_0	7	Preferred Generic	4	001000	1	2	1	1	111		01			1	30	60	90				1	2							30		34	5.00	10.00	15.00																																					5.00				5.00		0.17						0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	053	0	1	01	01	H5471_053_0	7	Preferred Generic	4	001000	1	2	1	3	111		01			1	30	60	90				1	2							30		34	5.00	10.00	15.00																																					5.00				5.00		0.17						0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	053	0	1	01	01	H5471_053_0	7	Generic	4	010000	1	2	2	1	111		01			1	30	60	90				1	2							30		34	10.00	20.00	30.00																																					10.00				10.00		0.33						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	053	0	1	01	01	H5471_053_0	7	Generic	4	010000	1	2	2	3	111		01			1	30	60	90				1	2							30		34	10.00	20.00	30.00																																					10.00				10.00		0.33						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	053	0	1	01	01	H5471_053_0	7	Preferred Brand	4	000001	1	2	3	1	111		01			1	30	60	90				1	2							30		34	15.00	30.00	45.00																																					15.00				15.00		0.50						0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	053	0	1	01	01	H5471_053_0	7	Non-Preferred Brand	4	100000	1	2	4	1	010		01			1	30														30		34	35.00																																							35.00				35.00		1.17						1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	053	0	1	01	01	H5471_053_0	7	Specialty Tier	4	010010	1	1	5	1	010		01			1	30														30		34					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	054	0	1	01	01	H5471_054_0	8	Preferred Generic	4	001000	3	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	054	0	1	01	01	H5471_054_0	8	Preferred Generic	4	001000	3	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5471	054	0	1	01	01	H5471_054_0	8	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	5.00	10.00	15.00																			5.00	15.00	15.00																5.00				5.00		0.17			0.17			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	054	0	1	01	01	H5471_054_0	8	Generic	4	010000	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	5.00	10.00	15.00																			5.00	15.00	15.00																5.00				5.00		0.17			0.17			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	054	0	1	01	01	H5471_054_0	8	Preferred Brand	4	000001	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		34	35.00	70.00	105.00																			35.00	105.00	105.00																35.00				35.00		1.17			1.17			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	054	0	1	01	01	H5471_054_0	8	Preferred Brand	4	000001	1	2	3	3	111		01	111		1	30	60	90				1	2	30	60	90				30		34	35.00	70.00	105.00																			35.00	105.00	105.00																35.00				35.00		1.17			1.17			1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H5471	054	0	1	01	01	H5471_054_0	8	Non-Preferred Brand	4	100000	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	054	0	1	01	01	H5471_054_0	8	Non-Preferred Brand	4	100000	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	054	0	1	01	01	H5471_054_0	8	Specialty Tier	4	010010	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	055	0	1	01	01	H5471_055_0	8	Preferred Generic	4	001000	3	2	1	1	111		01			1	30	60	90				1	2							30		34	5.00	10.00	15.00																																					5.00				5.00		0.17						0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	055	0	1	01	01	H5471_055_0	8	Preferred Generic	4	001000	3	2	1	3	111		01			1	30	60	90				1	2							30		34	5.00	10.00	15.00																																					5.00				5.00		0.17						0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5471	055	0	1	01	01	H5471_055_0	8	Generic	4	010000	1	2	2	1	111		01			1	30	60	90				1	2							30		34	10.00	20.00	30.00																																					10.00				10.00		0.33						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	055	0	1	01	01	H5471_055_0	8	Generic	4	010000	1	2	2	3	111		01			1	30	60	90				1	2							30		34	10.00	20.00	30.00																																					10.00				10.00		0.33						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	055	0	1	01	01	H5471_055_0	8	Preferred Brand	4	000001	1	2	3	1	111		01			1	30	60	90				1	2							30		34	15.00	30.00	45.00																																					15.00				15.00		0.50						0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	055	0	1	01	01	H5471_055_0	8	Non-Preferred Brand	4	100000	1	2	4	1	010		01			1	30														30		34	35.00																																							35.00				35.00		1.17						1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	055	0	1	01	01	H5471_055_0	8	Specialty Tier	4	010010	1	1	5	1	010		01			1	30														30		34					33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	056	0	1	01	01	H5471_056_0	9	Preferred Generic	4	001000	3	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	056	0	1	01	01	H5471_056_0	9	Preferred Generic	4	001000	3	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H5471	056	0	1	01	01	H5471_056_0	9	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	056	0	1	01	01	H5471_056_0	9	Generic	4	010000	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5471	056	0	1	01	01	H5471_056_0	9	Preferred Brand	4	000001	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								45.00	90.00	135.00					45.00	90.00	135.00					45.00	135.00	135.00																45.00				45.00			1.50	1.50	1.50			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5471	056	0	1	01	01	H5471_056_0	9	Non-Preferred Brand	4	100000	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	056	0	1	01	01	H5471_056_0	9	Specialty Tier	4	010010	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												
H5475	002	0	1	01	01	H5475_002_0	7	Preferred Generic	4	001010	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5475	002	0	1	01	01	H5475_002_0	7	Generic	4	010010	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	20.00		60.00																					40.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5475	002	0	1	01	01	H5475_002_0	7	Preferred Brand	4	010001	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	47.00		141.00																					94.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5475	002	0	1	01	01	H5475_002_0	7	Non-Preferred Brand	4	110000	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	100.00		300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5475	002	0	1	01	01	H5475_002_0	7	Specialty Tier	4	010010	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31					25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5475	003	0	1	01	01	H5475_003_0	8	Preferred Generic	4	001010	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5475	003	0	1	01	01	H5475_003_0	8	Generic	4	010010	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	15.00		30.00																					30.00																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5475	003	0	1	01	01	H5475_003_0	8	Preferred Brand	4	010001	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	45.00		90.00																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5475	003	0	1	01	01	H5475_003_0	8	Non-Preferred Brand	4	110000	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 Brand, Specialty Tier												
H5475	003	0	1	01	01	H5475_003_0	8	Specialty Tier	4	010010	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31					33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5475	005	0	1	01	01	H5475_005_0	8	Preferred Generic	4	001010	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5475	005	0	1	01	01	H5475_005_0	8	Generic	4	010010	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	20.00		60.00																					40.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5475	005	0	1	01	01	H5475_005_0	8	Preferred Brand	4	010001	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	47.00		141.00																					94.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5475	005	0	1	01	01	H5475_005_0	8	Non-Preferred Brand	4	110000	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	100.00		300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5475	005	0	1	01	01	H5475_005_0	8	Specialty Tier	4	010010	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31					33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5475	006	0	1	01	01	H5475_006_0	8	Preferred Generic	4	001010	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5475	006	0	1	01	01	H5475_006_0	8	Generic	4	010010	1	2	2	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												
H5475	006	0	1	01	01	H5475_006_0	8	Preferred Brand	4	010001	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	47.00		94.00																					94.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5475	006	0	1	01	01	H5475_006_0	8	Non-Preferred Brand	4	110000	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	100.00		300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5475	006	0	1	01	01	H5475_006_0	8	Specialty Tier	4	010010	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31					33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5520	002	0	1	04	01	H5520_002_0	4	Preferred Generic	4	001000	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	10.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	002	0	1	04	01	H5520_002_0	4	Generic	4	010000	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				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	002	0	1	04	01	H5520_002_0	4	Preferred Brand	4	010001	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	002	0	1	04	01	H5520_002_0	4	Non-Preferred Brand	4	110000	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	225.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	002	0	1	04	01	H5520_002_0	4	Specialty Tier	4	010010	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												31	31	31					31	31	31										31	31	31				31	31	31			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	002	0	1	04	01	H5520_002_0	4	Select Care Drugs	4	010010	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	004	0	1	04	01	H5520_004_0	6	Preferred Generic	4	001000	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	10.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	004	0	1	04	01	H5520_004_0	6	Generic	4	010000	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				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	004	0	1	04	01	H5520_004_0	6	Preferred Brand	4	010001	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	004	0	1	04	01	H5520_004_0	6	Non-Preferred Brand	4	110000	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	225.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	004	0	1	04	01	H5520_004_0	6	Specialty Tier	4	010010	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												31	31	31					31	31	31										31	31	31				31	31	31			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	004	0	1	04	01	H5520_004_0	6	Select Care Drugs	4	010010	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	012	1	1	04	01	H5520_012_1	5	Preferred Generic	3	001000	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	10.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	012	1	1	04	01	H5520_012_1	5	Generic	3	010000	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				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	012	1	1	04	01	H5520_012_1	5	Preferred Brand	3	010001	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	012	1	1	04	01	H5520_012_1	5	Non-Preferred Brand	3	110000	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	225.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	012	1	1	04	01	H5520_012_1	5	Specialty Tier	3	010010	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	30				30	30	30			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	012	1	1	04	01	H5520_012_1	5	Select Care Drugs	3	010010	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	012	2	1	04	01	H5520_012_2	5	Preferred Generic	3	001000	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	10.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	012	2	1	04	01	H5520_012_2	5	Generic	3	010000	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				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	012	2	1	04	01	H5520_012_2	5	Preferred Brand	3	010001	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	012	2	1	04	01	H5520_012_2	5	Non-Preferred Brand	3	110000	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	225.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	012	2	1	04	01	H5520_012_2	5	Specialty Tier	3	010010	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	30				30	30	30			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	012	2	1	04	01	H5520_012_2	5	Select Care Drugs	3	010010	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	012	3	1	04	01	H5520_012_3	5	Preferred Generic	3	001000	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	10.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	012	3	1	04	01	H5520_012_3	5	Generic	3	010000	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				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	012	3	1	04	01	H5520_012_3	5	Preferred Brand	3	010001	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	012	3	1	04	01	H5520_012_3	5	Non-Preferred Brand	3	110000	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	225.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	012	3	1	04	01	H5520_012_3	5	Specialty Tier	3	010010	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	30				30	30	30			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	012	3	1	04	01	H5520_012_3	5	Select Care Drugs	3	010010	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	012	4	1	04	01	H5520_012_4	5	Preferred Generic	3	001000	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	10.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	012	4	1	04	01	H5520_012_4	5	Generic	3	010000	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				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	012	4	1	04	01	H5520_012_4	5	Preferred Brand	3	010001	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	012	4	1	04	01	H5520_012_4	5	Non-Preferred Brand	3	110000	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	225.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	012	4	1	04	01	H5520_012_4	5	Specialty Tier	3	010010	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	30				30	30	30			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	012	4	1	04	01	H5520_012_4	5	Select Care Drugs	3	010010	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	014	0	1	04	01	H5520_014_0	5	Preferred Generic	4	001000	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	10.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	014	0	1	04	01	H5520_014_0	5	Generic	4	010000	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				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	014	0	1	04	01	H5520_014_0	5	Preferred Brand	4	010001	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	014	0	1	04	01	H5520_014_0	5	Non-Preferred Brand	4	110000	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	225.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	014	0	1	04	01	H5520_014_0	5	Specialty Tier	4	010010	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												29	29	29					29	29	29										29	29	29				29	29	29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	014	0	1	04	01	H5520_014_0	5	Select Care Drugs	4	010010	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	015	1	1	04	01	H5520_015_1	5	Preferred Generic	3	001000	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	10.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	015	1	1	04	01	H5520_015_1	5	Generic	3	010000	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				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	015	1	1	04	01	H5520_015_1	5	Preferred Brand	3	010001	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	015	1	1	04	01	H5520_015_1	5	Non-Preferred Brand	3	110000	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	225.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	015	1	1	04	01	H5520_015_1	5	Specialty Tier	3	010010	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	30				30	30	30			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	015	1	1	04	01	H5520_015_1	5	Select Care Drugs	3	010010	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	015	2	1	04	01	H5520_015_2	5	Preferred Generic	3	001000	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	10.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	015	2	1	04	01	H5520_015_2	5	Generic	3	010000	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				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	015	2	1	04	01	H5520_015_2	5	Preferred Brand	3	010001	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	015	2	1	04	01	H5520_015_2	5	Non-Preferred Brand	3	110000	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	225.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	015	2	1	04	01	H5520_015_2	5	Specialty Tier	3	010010	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	30				30	30	30			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5520	015	2	1	04	01	H5520_015_2	5	Select Care Drugs	3	010010	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5521	012	0	1	04	01	H5521_012_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	012	0	1	04	01	H5521_012_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	012	0	1	04	01	H5521_012_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	012	0	1	04	01	H5521_012_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	012	0	1	04	01	H5521_012_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	012	0	1	04	01	H5521_012_0	3	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	012	0	1	04	01	H5521_012_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	013	0	1	04	01	H5521_013_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	013	0	1	04	01	H5521_013_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	013	0	1	04	01	H5521_013_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	013	0	1	04	01	H5521_013_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	013	0	1	04	01	H5521_013_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	013	0	1	04	01	H5521_013_0	3	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	013	0	1	04	01	H5521_013_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	015	0	1	04	01	H5521_015_0	4	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	015	0	1	04	01	H5521_015_0	4	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	015	0	1	04	01	H5521_015_0	4	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	015	0	1	04	01	H5521_015_0	4	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	015	0	1	04	01	H5521_015_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	31						1.00	31												31						31						31		31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	016	0	1	04	01	H5521_016_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	016	0	1	04	01	H5521_016_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	016	0	1	04	01	H5521_016_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	016	0	1	04	01	H5521_016_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	016	0	1	04	01	H5521_016_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	016	0	1	04	01	H5521_016_0	3	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	016	0	1	04	01	H5521_016_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	020	0	1	04	01	H5521_020_0	4	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	020	0	1	04	01	H5521_020_0	4	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	020	0	1	04	01	H5521_020_0	4	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	020	0	1	04	01	H5521_020_0	4	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	020	0	1	04	01	H5521_020_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	020	0	1	04	01	H5521_020_0	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	020	0	1	04	01	H5521_020_0	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	29						1.00	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	022	0	1	04	01	H5521_022_0	5	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	022	0	1	04	01	H5521_022_0	5	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	022	0	1	04	01	H5521_022_0	5	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	022	0	1	04	01	H5521_022_0	5	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	022	0	1	04	01	H5521_022_0	5	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	5	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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	5	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	027	0	1	04	01	H5521_027_0	5	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	027	0	1	04	01	H5521_027_0	5	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	027	0	1	04	01	H5521_027_0	5	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	027	0	1	04	01	H5521_027_0	5	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	027	0	1	04	01	H5521_027_0	5	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	5	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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	5	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	033	0	1	04	01	H5521_033_0	5	Preferred Generic	4	001010	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												
H5521	033	0	1	04	01	H5521_033_0	5	Preferred Generic	4	001010	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
H5521	033	0	1	04	01	H5521_033_0	5	Generic	4	010010	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	033	0	1	04	01	H5521_033_0	5	Generic	4	010010	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5521	033	0	1	04	01	H5521_033_0	5	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	5	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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	5	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	037	0	1	04	01	H5521_037_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	037	0	1	04	01	H5521_037_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	037	0	1	04	01	H5521_037_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	037	0	1	04	01	H5521_037_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	037	0	1	04	01	H5521_037_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	037	0	1	04	01	H5521_037_0	3	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	037	0	1	04	01	H5521_037_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	040	0	1	04	01	H5521_040_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	040	0	1	04	01	H5521_040_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	040	0	1	04	01	H5521_040_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	040	0	1	04	01	H5521_040_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	040	0	1	04	01	H5521_040_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	040	0	1	04	01	H5521_040_0	3	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	040	0	1	04	01	H5521_040_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	28						1.00	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	053	0	1	04	01	H5521_053_0	4	Preferred Generic	4	001010	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	053	0	1	04	01	H5521_053_0	4	Preferred Generic	4	001010	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	053	0	1	04	01	H5521_053_0	4	Generic	4	010010	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	053	0	1	04	01	H5521_053_0	4	Generic	4	010010	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	053	0	1	04	01	H5521_053_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	055	0	1	04	01	H5521_055_0	5	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	055	0	1	04	01	H5521_055_0	5	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	055	0	1	04	01	H5521_055_0	5	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	055	0	1	04	01	H5521_055_0	5	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	055	0	1	04	01	H5521_055_0	5	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	5	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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	5	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	056	0	1	04	01	H5521_056_0	4	Preferred Generic	4	001010	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	056	0	1	04	01	H5521_056_0	4	Preferred Generic	4	001010	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	056	0	1	04	01	H5521_056_0	4	Generic	4	010010	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	056	0	1	04	01	H5521_056_0	4	Generic	4	010010	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	056	0	1	04	01	H5521_056_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	057	0	1	04	01	H5521_057_0	4	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	057	0	1	04	01	H5521_057_0	4	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	057	0	1	04	01	H5521_057_0	4	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	057	0	1	04	01	H5521_057_0	4	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	057	0	1	04	01	H5521_057_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	057	0	1	04	01	H5521_057_0	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	057	0	1	04	01	H5521_057_0	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	058	0	1	04	01	H5521_058_0	4	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	058	0	1	04	01	H5521_058_0	4	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	058	0	1	04	01	H5521_058_0	4	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	058	0	1	04	01	H5521_058_0	4	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	058	0	1	04	01	H5521_058_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	058	0	1	04	01	H5521_058_0	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	058	0	1	04	01	H5521_058_0	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	059	0	1	04	01	H5521_059_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	059	0	1	04	01	H5521_059_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	059	0	1	04	01	H5521_059_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	059	0	1	04	01	H5521_059_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	059	0	1	04	01	H5521_059_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	059	0	1	04	01	H5521_059_0	3	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	059	0	1	04	01	H5521_059_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	060	0	1	04	01	H5521_060_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	060	0	1	04	01	H5521_060_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	060	0	1	04	01	H5521_060_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	060	0	1	04	01	H5521_060_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	060	0	1	04	01	H5521_060_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	060	0	1	04	01	H5521_060_0	3	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	060	0	1	04	01	H5521_060_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	076	0	1	04	01	H5521_076_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	076	0	1	04	01	H5521_076_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	076	0	1	04	01	H5521_076_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	076	0	1	04	01	H5521_076_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	076	0	1	04	01	H5521_076_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	076	0	1	04	01	H5521_076_0	3	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	076	0	1	04	01	H5521_076_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	29						1.00	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	077	0	1	04	01	H5521_077_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	077	0	1	04	01	H5521_077_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	077	0	1	04	01	H5521_077_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	077	0	1	04	01	H5521_077_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	077	0	1	04	01	H5521_077_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	077	0	1	04	01	H5521_077_0	3	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	077	0	1	04	01	H5521_077_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	31						1.00	31												31						31						31		31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	081	0	1	04	01	H5521_081_0	6	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	081	0	1	04	01	H5521_081_0	6	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	081	0	1	04	01	H5521_081_0	6	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	081	0	1	04	01	H5521_081_0	6	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	081	0	1	04	01	H5521_081_0	6	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	6	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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	6	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	29						1.00	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	082	0	1	04	01	H5521_082_0	4	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	082	0	1	04	01	H5521_082_0	4	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	082	0	1	04	01	H5521_082_0	4	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	082	0	1	04	01	H5521_082_0	4	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	082	0	1	04	01	H5521_082_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	082	0	1	04	01	H5521_082_0	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	082	0	1	04	01	H5521_082_0	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	083	0	1	04	01	H5521_083_0	5	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	083	0	1	04	01	H5521_083_0	5	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	083	0	1	04	01	H5521_083_0	5	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	083	0	1	04	01	H5521_083_0	5	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	083	0	1	04	01	H5521_083_0	5	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	084	0	1	04	01	H5521_084_0	4	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	084	0	1	04	01	H5521_084_0	4	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	084	0	1	04	01	H5521_084_0	4	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	084	0	1	04	01	H5521_084_0	4	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	084	0	1	04	01	H5521_084_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	085	0	1	04	01	H5521_085_0	5	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	085	0	1	04	01	H5521_085_0	5	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	085	0	1	04	01	H5521_085_0	5	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	085	0	1	04	01	H5521_085_0	5	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	085	0	1	04	01	H5521_085_0	5	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	5	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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	5	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	29						1.00	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	086	0	1	04	01	H5521_086_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	086	0	1	04	01	H5521_086_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	086	0	1	04	01	H5521_086_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	086	0	1	04	01	H5521_086_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	086	0	1	04	01	H5521_086_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	086	0	1	04	01	H5521_086_0	3	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	086	0	1	04	01	H5521_086_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	087	0	1	04	01	H5521_087_0	4	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	087	0	1	04	01	H5521_087_0	4	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	087	0	1	04	01	H5521_087_0	4	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	087	0	1	04	01	H5521_087_0	4	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	087	0	1	04	01	H5521_087_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	30						1.00	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	088	0	1	04	01	H5521_088_0	4	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	088	0	1	04	01	H5521_088_0	4	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	088	0	1	04	01	H5521_088_0	4	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	088	0	1	04	01	H5521_088_0	4	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	088	0	1	04	01	H5521_088_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	30						1.00	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	089	0	1	04	01	H5521_089_0	4	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	089	0	1	04	01	H5521_089_0	4	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	089	0	1	04	01	H5521_089_0	4	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	089	0	1	04	01	H5521_089_0	4	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	089	0	1	04	01	H5521_089_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	29						1.00	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	090	0	1	04	01	H5521_090_0	4	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	090	0	1	04	01	H5521_090_0	4	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	090	0	1	04	01	H5521_090_0	4	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	090	0	1	04	01	H5521_090_0	4	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	090	0	1	04	01	H5521_090_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	30						1.00	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	091	0	1	04	01	H5521_091_0	4	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	091	0	1	04	01	H5521_091_0	4	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	091	0	1	04	01	H5521_091_0	4	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	091	0	1	04	01	H5521_091_0	4	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	091	0	1	04	01	H5521_091_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	091	0	1	04	01	H5521_091_0	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	091	0	1	04	01	H5521_091_0	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	29						1.00	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	092	0	1	04	01	H5521_092_0	4	Preferred Generic	4	001010	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	092	0	1	04	01	H5521_092_0	4	Preferred Generic	4	001010	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	092	0	1	04	01	H5521_092_0	4	Generic	4	010010	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	092	0	1	04	01	H5521_092_0	4	Generic	4	010010	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	092	0	1	04	01	H5521_092_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	092	0	1	04	01	H5521_092_0	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	092	0	1	04	01	H5521_092_0	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	093	0	1	04	01	H5521_093_0	4	Preferred Generic	4	001010	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	093	0	1	04	01	H5521_093_0	4	Preferred Generic	4	001010	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	093	0	1	04	01	H5521_093_0	4	Generic	4	010010	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	093	0	1	04	01	H5521_093_0	4	Generic	4	010010	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	093	0	1	04	01	H5521_093_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	093	0	1	04	01	H5521_093_0	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	093	0	1	04	01	H5521_093_0	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	094	0	1	04	01	H5521_094_0	4	Preferred Generic	4	001010	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	094	0	1	04	01	H5521_094_0	4	Preferred Generic	4	001010	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	094	0	1	04	01	H5521_094_0	4	Generic	4	010010	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	094	0	1	04	01	H5521_094_0	4	Generic	4	010010	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00					10.00			10.00			0.33	0.00		0.33	0.00	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	094	0	1	04	01	H5521_094_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	094	0	1	04	01	H5521_094_0	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	094	0	1	04	01	H5521_094_0	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	095	0	1	04	01	H5521_095_0	4	Preferred Generic	4	001010	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	095	0	1	04	01	H5521_095_0	4	Preferred Generic	4	001010	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	095	0	1	04	01	H5521_095_0	4	Generic	4	010010	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	095	0	1	04	01	H5521_095_0	4	Generic	4	010010	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	095	0	1	04	01	H5521_095_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	098	0	1	04	01	H5521_098_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	098	0	1	04	01	H5521_098_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	098	0	1	04	01	H5521_098_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	098	0	1	04	01	H5521_098_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	098	0	1	04	01	H5521_098_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	098	0	1	04	01	H5521_098_0	3	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	098	0	1	04	01	H5521_098_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	31						1.00	31												31						31						31		31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	099	0	1	04	01	H5521_099_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	099	0	1	04	01	H5521_099_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	099	0	1	04	01	H5521_099_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	099	0	1	04	01	H5521_099_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	099	0	1	04	01	H5521_099_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	099	0	1	04	01	H5521_099_0	3	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	099	0	1	04	01	H5521_099_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	100	0	1	04	01	H5521_100_0	4	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	100	0	1	04	01	H5521_100_0	4	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	100	0	1	04	01	H5521_100_0	4	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	100	0	1	04	01	H5521_100_0	4	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	100	0	1	04	01	H5521_100_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	101	0	1	04	01	H5521_101_0	5	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	101	0	1	04	01	H5521_101_0	5	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	101	0	1	04	01	H5521_101_0	5	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	101	0	1	04	01	H5521_101_0	5	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	101	0	1	04	01	H5521_101_0	5	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	5	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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	5	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	102	0	1	04	01	H5521_102_0	4	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	102	0	1	04	01	H5521_102_0	4	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	102	0	1	04	01	H5521_102_0	4	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	102	0	1	04	01	H5521_102_0	4	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	102	0	1	04	01	H5521_102_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	103	0	1	04	01	H5521_103_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	103	0	1	04	01	H5521_103_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	103	0	1	04	01	H5521_103_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	103	0	1	04	01	H5521_103_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	103	0	1	04	01	H5521_103_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	103	0	1	04	01	H5521_103_0	3	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	103	0	1	04	01	H5521_103_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	104	0	1	04	01	H5521_104_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	104	0	1	04	01	H5521_104_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	104	0	1	04	01	H5521_104_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	104	0	1	04	01	H5521_104_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	104	0	1	04	01	H5521_104_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	104	0	1	04	01	H5521_104_0	3	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	104	0	1	04	01	H5521_104_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	105	0	1	04	01	H5521_105_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	105	0	1	04	01	H5521_105_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	105	0	1	04	01	H5521_105_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	105	0	1	04	01	H5521_105_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	105	0	1	04	01	H5521_105_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	105	0	1	04	01	H5521_105_0	3	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	105	0	1	04	01	H5521_105_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	106	0	1	04	01	H5521_106_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	106	0	1	04	01	H5521_106_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	106	0	1	04	01	H5521_106_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	106	0	1	04	01	H5521_106_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	106	0	1	04	01	H5521_106_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	106	0	1	04	01	H5521_106_0	3	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	106	0	1	04	01	H5521_106_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	107	0	1	04	01	H5521_107_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	107	0	1	04	01	H5521_107_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	107	0	1	04	01	H5521_107_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	107	0	1	04	01	H5521_107_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	107	0	1	04	01	H5521_107_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	107	0	1	04	01	H5521_107_0	3	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	107	0	1	04	01	H5521_107_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	108	0	1	04	01	H5521_108_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	108	0	1	04	01	H5521_108_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	108	0	1	04	01	H5521_108_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	108	0	1	04	01	H5521_108_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	108	0	1	04	01	H5521_108_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	108	0	1	04	01	H5521_108_0	3	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	108	0	1	04	01	H5521_108_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	109	0	1	04	01	H5521_109_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	109	0	1	04	01	H5521_109_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	109	0	1	04	01	H5521_109_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	109	0	1	04	01	H5521_109_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	109	0	1	04	01	H5521_109_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	109	0	1	04	01	H5521_109_0	3	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	109	0	1	04	01	H5521_109_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	110	0	1	04	01	H5521_110_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	110	0	1	04	01	H5521_110_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	110	0	1	04	01	H5521_110_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	110	0	1	04	01	H5521_110_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	110	0	1	04	01	H5521_110_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	110	0	1	04	01	H5521_110_0	3	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	110	0	1	04	01	H5521_110_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	29						1.00	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	111	0	1	04	01	H5521_111_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	111	0	1	04	01	H5521_111_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	111	0	1	04	01	H5521_111_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	111	0	1	04	01	H5521_111_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	111	0	1	04	01	H5521_111_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	111	0	1	04	01	H5521_111_0	3	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	111	0	1	04	01	H5521_111_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	29						1.00	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	112	0	1	04	01	H5521_112_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	112	0	1	04	01	H5521_112_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	112	0	1	04	01	H5521_112_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	112	0	1	04	01	H5521_112_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	112	0	1	04	01	H5521_112_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	112	0	1	04	01	H5521_112_0	3	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	112	0	1	04	01	H5521_112_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	31						1.00	31												31						31						31		31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	113	0	1	04	01	H5521_113_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	113	0	1	04	01	H5521_113_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	113	0	1	04	01	H5521_113_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	113	0	1	04	01	H5521_113_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	113	0	1	04	01	H5521_113_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	113	0	1	04	01	H5521_113_0	3	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	113	0	1	04	01	H5521_113_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	28						1.00	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	114	0	1	04	01	H5521_114_0	4	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	114	0	1	04	01	H5521_114_0	4	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	114	0	1	04	01	H5521_114_0	4	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	114	0	1	04	01	H5521_114_0	4	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	114	0	1	04	01	H5521_114_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	114	0	1	04	01	H5521_114_0	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	114	0	1	04	01	H5521_114_0	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	115	0	1	04	01	H5521_115_0	4	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	115	0	1	04	01	H5521_115_0	4	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	115	0	1	04	01	H5521_115_0	4	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	115	0	1	04	01	H5521_115_0	4	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	115	0	1	04	01	H5521_115_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	115	0	1	04	01	H5521_115_0	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	115	0	1	04	01	H5521_115_0	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	116	0	1	04	01	H5521_116_0	5	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	116	0	1	04	01	H5521_116_0	5	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	116	0	1	04	01	H5521_116_0	5	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	116	0	1	04	01	H5521_116_0	5	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	116	0	1	04	01	H5521_116_0	5	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	5	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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	5	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	117	0	1	04	01	H5521_117_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	117	0	1	04	01	H5521_117_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	117	0	1	04	01	H5521_117_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	117	0	1	04	01	H5521_117_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	117	0	1	04	01	H5521_117_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	117	0	1	04	01	H5521_117_0	3	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	117	0	1	04	01	H5521_117_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	28						1.00	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	118	0	1	04	01	H5521_118_0	4	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	118	0	1	04	01	H5521_118_0	4	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	118	0	1	04	01	H5521_118_0	4	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	118	0	1	04	01	H5521_118_0	4	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	118	0	1	04	01	H5521_118_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	118	0	1	04	01	H5521_118_0	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	118	0	1	04	01	H5521_118_0	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	29						1.00	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	119	0	1	04	01	H5521_119_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	119	0	1	04	01	H5521_119_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	119	0	1	04	01	H5521_119_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	119	0	1	04	01	H5521_119_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	119	0	1	04	01	H5521_119_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	119	0	1	04	01	H5521_119_0	3	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	119	0	1	04	01	H5521_119_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	30						1.00	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	120	0	1	04	01	H5521_120_0	4	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	120	0	1	04	01	H5521_120_0	4	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	120	0	1	04	01	H5521_120_0	4	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	120	0	1	04	01	H5521_120_0	4	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	120	0	1	04	01	H5521_120_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	120	0	1	04	01	H5521_120_0	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	120	0	1	04	01	H5521_120_0	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	28						1.00	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	121	0	1	04	01	H5521_121_0	4	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	121	0	1	04	01	H5521_121_0	4	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	121	0	1	04	01	H5521_121_0	4	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	121	0	1	04	01	H5521_121_0	4	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	121	0	1	04	01	H5521_121_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	29						1.00	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	122	0	1	04	01	H5521_122_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	122	0	1	04	01	H5521_122_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	122	0	1	04	01	H5521_122_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	122	0	1	04	01	H5521_122_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	122	0	1	04	01	H5521_122_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	122	0	1	04	01	H5521_122_0	3	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	122	0	1	04	01	H5521_122_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	123	0	1	04	01	H5521_123_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	123	0	1	04	01	H5521_123_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	123	0	1	04	01	H5521_123_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	123	0	1	04	01	H5521_123_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	123	0	1	04	01	H5521_123_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	3	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	124	0	1	04	01	H5521_124_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	124	0	1	04	01	H5521_124_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	124	0	1	04	01	H5521_124_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	124	0	1	04	01	H5521_124_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	124	0	1	04	01	H5521_124_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	124	0	1	04	01	H5521_124_0	3	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	124	0	1	04	01	H5521_124_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	125	0	1	04	01	H5521_125_0	4	Preferred Generic	4	001010	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	125	0	1	04	01	H5521_125_0	4	Preferred Generic	4	001010	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	125	0	1	04	01	H5521_125_0	4	Generic	4	010010	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	125	0	1	04	01	H5521_125_0	4	Generic	4	010010	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	125	0	1	04	01	H5521_125_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	126	0	1	04	01	H5521_126_0	4	Preferred Generic	4	001010	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	126	0	1	04	01	H5521_126_0	4	Preferred Generic	4	001010	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	126	0	1	04	01	H5521_126_0	4	Generic	4	010010	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	126	0	1	04	01	H5521_126_0	4	Generic	4	010010	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	126	0	1	04	01	H5521_126_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	126	0	1	04	01	H5521_126_0	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	126	0	1	04	01	H5521_126_0	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	127	0	1	04	01	H5521_127_0	4	Preferred Generic	4	001010	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	127	0	1	04	01	H5521_127_0	4	Preferred Generic	4	001010	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	127	0	1	04	01	H5521_127_0	4	Generic	4	010010	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	127	0	1	04	01	H5521_127_0	4	Generic	4	010010	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	127	0	1	04	01	H5521_127_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	128	0	1	04	01	H5521_128_0	4	Preferred Generic	4	001010	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	128	0	1	04	01	H5521_128_0	4	Preferred Generic	4	001010	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	128	0	1	04	01	H5521_128_0	4	Generic	4	010010	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	128	0	1	04	01	H5521_128_0	4	Generic	4	010010	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	128	0	1	04	01	H5521_128_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	130	0	1	04	01	H5521_130_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	130	0	1	04	01	H5521_130_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	130	0	1	04	01	H5521_130_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	130	0	1	04	01	H5521_130_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	130	0	1	04	01	H5521_130_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	130	0	1	04	01	H5521_130_0	3	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	130	0	1	04	01	H5521_130_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	131	0	1	04	01	H5521_131_0	5	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	131	0	1	04	01	H5521_131_0	5	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	131	0	1	04	01	H5521_131_0	5	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	131	0	1	04	01	H5521_131_0	5	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	131	0	1	04	01	H5521_131_0	5	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	131	0	1	04	01	H5521_131_0	5	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	131	0	1	04	01	H5521_131_0	5	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	132	0	1	04	01	H5521_132_0	5	Preferred Generic	4	001010	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												
H5521	132	0	1	04	01	H5521_132_0	5	Preferred Generic	4	001010	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
H5521	132	0	1	04	01	H5521_132_0	5	Generic	4	010010	3	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	132	0	1	04	01	H5521_132_0	5	Generic	4	010010	3	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5521	132	0	1	04	01	H5521_132_0	5	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	132	0	1	04	01	H5521_132_0	5	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	132	0	1	04	01	H5521_132_0	5	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	133	0	1	04	01	H5521_133_0	5	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	133	0	1	04	01	H5521_133_0	5	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00					5.00			5.00			0.17	0.00		0.17	0.00	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	133	0	1	04	01	H5521_133_0	5	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	133	0	1	04	01	H5521_133_0	5	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					5.00	10.00	15.00											10.00	20.00	30.00				5.00	10.00	15.00					10.00			10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	133	0	1	04	01	H5521_133_0	5	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	133	0	1	04	01	H5521_133_0	5	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	133	0	1	04	01	H5521_133_0	5	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	134	0	1	04	01	H5521_134_0	4	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	134	0	1	04	01	H5521_134_0	4	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	134	0	1	04	01	H5521_134_0	4	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	134	0	1	04	01	H5521_134_0	4	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	134	0	1	04	01	H5521_134_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	134	0	1	04	01	H5521_134_0	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	134	0	1	04	01	H5521_134_0	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	135	0	1	04	01	H5521_135_0	4	Preferred Generic	3	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	135	0	1	04	01	H5521_135_0	4	Generic	3	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	135	0	1	04	01	H5521_135_0	4	Preferred Brand	3	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	135	0	1	04	01	H5521_135_0	4	Non-Preferred Drug	3	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	135	0	1	04	01	H5521_135_0	4	Specialty Tier	3	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	28						1.00	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	136	0	1	04	01	H5521_136_0	4	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	136	0	1	04	01	H5521_136_0	4	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	136	0	1	04	01	H5521_136_0	4	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	136	0	1	04	01	H5521_136_0	4	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	136	0	1	04	01	H5521_136_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	136	0	1	04	01	H5521_136_0	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	136	0	1	04	01	H5521_136_0	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	25						1.00	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	139	0	1	04	01	H5521_139_0	4	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	139	0	1	04	01	H5521_139_0	4	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	139	0	1	04	01	H5521_139_0	4	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	139	0	1	04	01	H5521_139_0	4	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	139	0	1	04	01	H5521_139_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	29						1.00	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	140	0	1	04	01	H5521_140_0	4	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	140	0	1	04	01	H5521_140_0	4	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	140	0	1	04	01	H5521_140_0	4	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	140	0	1	04	01	H5521_140_0	4	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	140	0	1	04	01	H5521_140_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	29						1.00	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	141	0	1	04	01	H5521_141_0	4	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	141	0	1	04	01	H5521_141_0	4	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	141	0	1	04	01	H5521_141_0	4	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	141	0	1	04	01	H5521_141_0	4	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	141	0	1	04	01	H5521_141_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	142	0	1	04	01	H5521_142_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	142	0	1	04	01	H5521_142_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	142	0	1	04	01	H5521_142_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	142	0	1	04	01	H5521_142_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	142	0	1	04	01	H5521_142_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	142	0	1	04	01	H5521_142_0	3	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	142	0	1	04	01	H5521_142_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	143	0	1	04	01	H5521_143_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	143	0	1	04	01	H5521_143_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	143	0	1	04	01	H5521_143_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	143	0	1	04	01	H5521_143_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	143	0	1	04	01	H5521_143_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	143	0	1	04	01	H5521_143_0	3	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	143	0	1	04	01	H5521_143_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	144	0	1	04	01	H5521_144_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	144	0	1	04	01	H5521_144_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	144	0	1	04	01	H5521_144_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	144	0	1	04	01	H5521_144_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	144	0	1	04	01	H5521_144_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	144	0	1	04	01	H5521_144_0	3	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	144	0	1	04	01	H5521_144_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	30						1.00	30												30						30						30		30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	145	0	1	04	01	H5521_145_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	145	0	1	04	01	H5521_145_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	145	0	1	04	01	H5521_145_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	145	0	1	04	01	H5521_145_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	145	0	1	04	01	H5521_145_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	145	0	1	04	01	H5521_145_0	3	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	145	0	1	04	01	H5521_145_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	146	0	1	04	01	H5521_146_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	146	0	1	04	01	H5521_146_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	146	0	1	04	01	H5521_146_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	146	0	1	04	01	H5521_146_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	146	0	1	04	01	H5521_146_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	146	0	1	04	01	H5521_146_0	3	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	146	0	1	04	01	H5521_146_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	147	0	1	04	01	H5521_147_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	147	0	1	04	01	H5521_147_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	147	0	1	04	01	H5521_147_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	147	0	1	04	01	H5521_147_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	147	0	1	04	01	H5521_147_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	147	0	1	04	01	H5521_147_0	3	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	147	0	1	04	01	H5521_147_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	148	0	1	04	01	H5521_148_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	148	0	1	04	01	H5521_148_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	148	0	1	04	01	H5521_148_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	148	0	1	04	01	H5521_148_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	148	0	1	04	01	H5521_148_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	148	0	1	04	01	H5521_148_0	3	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	148	0	1	04	01	H5521_148_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	27						1.00	27												27						27						27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	149	0	1	04	01	H5521_149_0	3	Preferred Generic	3	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	149	0	1	04	01	H5521_149_0	3	Generic	3	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	149	0	1	04	01	H5521_149_0	3	Preferred Brand	3	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	149	0	1	04	01	H5521_149_0	3	Non-Preferred Drug	3	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	149	0	1	04	01	H5521_149_0	3	Specialty Tier	3	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	28						1.00	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	150	0	1	04	01	H5521_150_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	150	0	1	04	01	H5521_150_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	150	0	1	04	01	H5521_150_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	150	0	1	04	01	H5521_150_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	150	0	1	04	01	H5521_150_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	150	0	1	04	01	H5521_150_0	3	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	150	0	1	04	01	H5521_150_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	27						1.00	27												27						27						27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	151	0	1	04	01	H5521_151_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	151	0	1	04	01	H5521_151_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	151	0	1	04	01	H5521_151_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	151	0	1	04	01	H5521_151_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	151	0	1	04	01	H5521_151_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	151	0	1	04	01	H5521_151_0	3	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	151	0	1	04	01	H5521_151_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	27						1.00	27												27						27						27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	152	0	1	04	01	H5521_152_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	152	0	1	04	01	H5521_152_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	152	0	1	04	01	H5521_152_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	152	0	1	04	01	H5521_152_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	152	0	1	04	01	H5521_152_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	152	0	1	04	01	H5521_152_0	3	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	152	0	1	04	01	H5521_152_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	153	0	1	04	01	H5521_153_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	153	0	1	04	01	H5521_153_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	153	0	1	04	01	H5521_153_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	153	0	1	04	01	H5521_153_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	153	0	1	04	01	H5521_153_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	153	0	1	04	01	H5521_153_0	3	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	153	0	1	04	01	H5521_153_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	154	0	1	04	01	H5521_154_0	5	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	154	0	1	04	01	H5521_154_0	5	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	154	0	1	04	01	H5521_154_0	5	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5521	154	0	1	04	01	H5521_154_0	5	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5521	154	0	1	04	01	H5521_154_0	5	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			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	5	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			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	5	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	29						1.00	29												29						29						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	001	0	1	04	01	H5522_001_0	4	Preferred Generic	4	001010	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	001	0	1	04	01	H5522_001_0	4	Preferred Generic	4	001010	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5522	001	0	1	04	01	H5522_001_0	4	Generic	4	010010	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	001	0	1	04	01	H5522_001_0	4	Generic	4	010010	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5522	001	0	1	04	01	H5522_001_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	001	0	1	04	01	H5522_001_0	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	001	0	1	04	01	H5522_001_0	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	002	0	1	04	01	H5522_002_0	4	Preferred Generic	4	001010	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	002	0	1	04	01	H5522_002_0	4	Preferred Generic	4	001010	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5522	002	0	1	04	01	H5522_002_0	4	Generic	4	010010	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	002	0	1	04	01	H5522_002_0	4	Generic	4	010010	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5522	002	0	1	04	01	H5522_002_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	002	0	1	04	01	H5522_002_0	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	002	0	1	04	01	H5522_002_0	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	004	0	1	04	01	H5522_004_0	5	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	004	0	1	04	01	H5522_004_0	5	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5522	004	0	1	04	01	H5522_004_0	5	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	004	0	1	04	01	H5522_004_0	5	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5522	004	0	1	04	01	H5522_004_0	5	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	5	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	5	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	005	0	1	04	01	H5522_005_0	4	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	005	0	1	04	01	H5522_005_0	4	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5522	005	0	1	04	01	H5522_005_0	4	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	005	0	1	04	01	H5522_005_0	4	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5522	005	0	1	04	01	H5522_005_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	013	0	1	04	01	H5522_013_0	4	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	013	0	1	04	01	H5522_013_0	4	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5522	013	0	1	04	01	H5522_013_0	4	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	013	0	1	04	01	H5522_013_0	4	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5522	013	0	1	04	01	H5522_013_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	014	0	1	04	01	H5522_014_0	4	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	014	0	1	04	01	H5522_014_0	4	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5522	014	0	1	04	01	H5522_014_0	4	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	014	0	1	04	01	H5522_014_0	4	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5522	014	0	1	04	01	H5522_014_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	017	0	1	04	01	H5522_017_0	4	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	017	0	1	04	01	H5522_017_0	4	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5522	017	0	1	04	01	H5522_017_0	4	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	017	0	1	04	01	H5522_017_0	4	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5522	017	0	1	04	01	H5522_017_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	25						1.00	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	018	0	1	04	01	H5522_018_0	4	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	018	0	1	04	01	H5522_018_0	4	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5522	018	0	1	04	01	H5522_018_0	4	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	018	0	1	04	01	H5522_018_0	4	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5522	018	0	1	04	01	H5522_018_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	018	0	1	04	01	H5522_018_0	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5522	018	0	1	04	01	H5522_018_0	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	004	0	1	04	01	H5525_004_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	004	0	1	04	01	H5525_004_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5525	004	0	1	04	01	H5525_004_0	3	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	004	0	1	04	01	H5525_004_0	3	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5525	004	0	1	04	01	H5525_004_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	004	0	1	04	01	H5525_004_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5525	004	0	1	04	01	H5525_004_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	004	0	1	04	01	H5525_004_0	3	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5525	004	0	1	04	01	H5525_004_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	004	0	1	04	01	H5525_004_0	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5525	005	0	1	04	01	H5525_005_0	6	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	005	0	1	04	01	H5525_005_0	6	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5525	005	0	1	04	01	H5525_005_0	6	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	005	0	1	04	01	H5525_005_0	6	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5525	005	0	1	04	01	H5525_005_0	6	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	005	0	1	04	01	H5525_005_0	6	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5525	005	0	1	04	01	H5525_005_0	6	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	005	0	1	04	01	H5525_005_0	6	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5525	005	0	1	04	01	H5525_005_0	6	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	005	0	1	04	01	H5525_005_0	6	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5525	006	0	1	04	01	H5525_006_0	6	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	006	0	1	04	01	H5525_006_0	6	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5525	006	0	1	04	01	H5525_006_0	6	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	006	0	1	04	01	H5525_006_0	6	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5525	006	0	1	04	01	H5525_006_0	6	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	006	0	1	04	01	H5525_006_0	6	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5525	006	0	1	04	01	H5525_006_0	6	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	006	0	1	04	01	H5525_006_0	6	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5525	006	0	1	04	01	H5525_006_0	6	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	006	0	1	04	01	H5525_006_0	6	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5525	007	0	1	04	01	H5525_007_0	6	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	007	0	1	04	01	H5525_007_0	6	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5525	007	0	1	04	01	H5525_007_0	6	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	007	0	1	04	01	H5525_007_0	6	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5525	007	0	1	04	01	H5525_007_0	6	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	007	0	1	04	01	H5525_007_0	6	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5525	007	0	1	04	01	H5525_007_0	6	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	007	0	1	04	01	H5525_007_0	6	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5525	007	0	1	04	01	H5525_007_0	6	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	007	0	1	04	01	H5525_007_0	6	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5525	008	0	1	04	01	H5525_008_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	008	0	1	04	01	H5525_008_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5525	008	0	1	04	01	H5525_008_0	3	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	008	0	1	04	01	H5525_008_0	3	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5525	008	0	1	04	01	H5525_008_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	008	0	1	04	01	H5525_008_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5525	008	0	1	04	01	H5525_008_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	008	0	1	04	01	H5525_008_0	3	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5525	008	0	1	04	01	H5525_008_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	008	0	1	04	01	H5525_008_0	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5525	015	0	1	04	01	H5525_015_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	015	0	1	04	01	H5525_015_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5525	015	0	1	04	01	H5525_015_0	3	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	015	0	1	04	01	H5525_015_0	3	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5525	015	0	1	04	01	H5525_015_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	015	0	1	04	01	H5525_015_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5525	015	0	1	04	01	H5525_015_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	015	0	1	04	01	H5525_015_0	3	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5525	015	0	1	04	01	H5525_015_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	015	0	1	04	01	H5525_015_0	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5525	017	0	1	04	01	H5525_017_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	017	0	1	04	01	H5525_017_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5525	017	0	1	04	01	H5525_017_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	017	0	1	04	01	H5525_017_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5525	017	0	1	04	01	H5525_017_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	017	0	1	04	01	H5525_017_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5525	017	0	1	04	01	H5525_017_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	017	0	1	04	01	H5525_017_0	4	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5525	017	0	1	04	01	H5525_017_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	017	0	1	04	01	H5525_017_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5525	020	0	1	04	01	H5525_020_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	020	0	1	04	01	H5525_020_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5525	020	0	1	04	01	H5525_020_0	3	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	020	0	1	04	01	H5525_020_0	3	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5525	020	0	1	04	01	H5525_020_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	020	0	1	04	01	H5525_020_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5525	020	0	1	04	01	H5525_020_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	020	0	1	04	01	H5525_020_0	3	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5525	020	0	1	04	01	H5525_020_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	020	0	1	04	01	H5525_020_0	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5525	022	0	1	04	01	H5525_022_0	6	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	022	0	1	04	01	H5525_022_0	6	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5525	022	0	1	04	01	H5525_022_0	6	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	022	0	1	04	01	H5525_022_0	6	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5525	022	0	1	04	01	H5525_022_0	6	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	022	0	1	04	01	H5525_022_0	6	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5525	022	0	1	04	01	H5525_022_0	6	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	022	0	1	04	01	H5525_022_0	6	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5525	022	0	1	04	01	H5525_022_0	6	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	022	0	1	04	01	H5525_022_0	6	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5525	023	0	1	04	01	H5525_023_0	6	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	023	0	1	04	01	H5525_023_0	6	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5525	023	0	1	04	01	H5525_023_0	6	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	023	0	1	04	01	H5525_023_0	6	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5525	023	0	1	04	01	H5525_023_0	6	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	023	0	1	04	01	H5525_023_0	6	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5525	023	0	1	04	01	H5525_023_0	6	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	023	0	1	04	01	H5525_023_0	6	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5525	023	0	1	04	01	H5525_023_0	6	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	023	0	1	04	01	H5525_023_0	6	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5525	024	0	1	04	01	H5525_024_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	024	0	1	04	01	H5525_024_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5525	024	0	1	04	01	H5525_024_0	3	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	024	0	1	04	01	H5525_024_0	3	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5525	024	0	1	04	01	H5525_024_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	024	0	1	04	01	H5525_024_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5525	024	0	1	04	01	H5525_024_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	024	0	1	04	01	H5525_024_0	3	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5525	024	0	1	04	01	H5525_024_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	024	0	1	04	01	H5525_024_0	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5525	025	0	1	04	01	H5525_025_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	025	0	1	04	01	H5525_025_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5525	025	0	1	04	01	H5525_025_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	025	0	1	04	01	H5525_025_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5525	025	0	1	04	01	H5525_025_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	025	0	1	04	01	H5525_025_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5525	025	0	1	04	01	H5525_025_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	025	0	1	04	01	H5525_025_0	4	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5525	025	0	1	04	01	H5525_025_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	025	0	1	04	01	H5525_025_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5525	026	0	1	04	01	H5525_026_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	026	0	1	04	01	H5525_026_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5525	026	0	1	04	01	H5525_026_0	3	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	026	0	1	04	01	H5525_026_0	3	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5525	026	0	1	04	01	H5525_026_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	026	0	1	04	01	H5525_026_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5525	026	0	1	04	01	H5525_026_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	026	0	1	04	01	H5525_026_0	3	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5525	026	0	1	04	01	H5525_026_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	026	0	1	04	01	H5525_026_0	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5525	027	0	1	04	01	H5525_027_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								9.00		27.00					4.00		12.00											9.00		27.00				4.00		0.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	027	0	1	04	01	H5525_027_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								9.00		27.00					4.00		12.00											9.00		27.00				4.00		0.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5525	027	0	1	04	01	H5525_027_0	3	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					18.00		54.00											20.00		60.00				18.00		0.00				20.00				20.00			0.67	0.60		0.67	0.60	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	027	0	1	04	01	H5525_027_0	3	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					18.00		54.00											20.00		60.00				18.00		0.00				20.00				20.00			0.67	0.60		0.67	0.60	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5525	027	0	1	04	01	H5525_027_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	027	0	1	04	01	H5525_027_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5525	027	0	1	04	01	H5525_027_0	3	Non-Preferred Drug	4	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											76.00	50		50				76.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	027	0	1	04	01	H5525_027_0	3	Non-Preferred Drug	4	110000	1	1	4	3		110	01		110	1				30		90	2	2				30		90	30		31											77.00	31		31				76.00	31		31										31		31				31		31			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5525	027	0	1	04	01	H5525_027_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	027	0	1	04	01	H5525_027_0	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5525	030	0	1	04	01	H5525_030_0	5	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								6.00		18.00					1.00		3.00											6.00		18.00				1.00		0.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	030	0	1	04	01	H5525_030_0	5	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								6.00		18.00					1.00		3.00											6.00		18.00				1.00		0.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5525	030	0	1	04	01	H5525_030_0	5	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								9.00		27.00					4.00		12.00											9.00		27.00				4.00		0.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	030	0	1	04	01	H5525_030_0	5	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								9.00		27.00					4.00		12.00											9.00		27.00				4.00		0.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5525	030	0	1	04	01	H5525_030_0	5	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	030	0	1	04	01	H5525_030_0	5	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5525	030	0	1	04	01	H5525_030_0	5	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	030	0	1	04	01	H5525_030_0	5	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5525	030	0	1	04	01	H5525_030_0	5	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5525	030	0	1	04	01	H5525_030_0	5	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5526	004	0	1	04	01	H5526_004_0	6	Preferred Generic	4	001000	1	2	1	1		110	10	110		1				30		90	1	2	30		90					29	31								10.00		30.00					5.00		15.00					5.00		12.50																	10.00			10.00			0.33	0.17	0.17			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	004	0	1	04	01	H5526_004_0	6	Preferred Generic	4	001000	1	2	1	3		110	10	110		1				30		90	1	2	30		90					29	31								10.00		30.00					5.00		15.00					5.00		12.50																	10.00			10.00			0.33	0.17	0.17			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5526	004	0	1	04	01	H5526_004_0	6	Generic	4	010000	1	2	2	1		110	10	110		1				30		90	1	2	30		90					29	31								20.00		60.00					15.00		45.00					15.00		37.50																	20.00			20.00			0.67	0.50	0.50			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	004	0	1	04	01	H5526_004_0	6	Preferred Brand	4	000001	1	2	3	1		110	10	110		1				30		90	1	2	30		90					29	31								47.00		141.00					42.00		126.00					42.00		105.00																	47.00			47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	004	0	1	04	01	H5526_004_0	6	Non-Preferred Drug	4	100100	1	2	4	1		110	10	110		1				30		90	1	2	30		90					29	31								100.00		300.00					94.00		282.00					94.00		235.00																	100.00			100.00			3.33	3.13	3.13			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	004	0	1	04	01	H5526_004_0	6	Specialty Tier	4	010010	1	1	5	1		110	10	110		1				30		90	1	2	30		90					29	31												33		33					33		33				33		33																33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	016	0	1	04	01	H5526_016_0	4	Preferred Generic	4	001000	1	2	1	1		110	10	110		1				30		90	1	2	30		90					29	31								12.00		36.00					7.00		21.00					7.00		17.50																	12.00			12.00			0.40	0.23	0.23			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	016	0	1	04	01	H5526_016_0	4	Generic	4	010000	1	2	2	1		110	10	110		1				30		90	1	2	30		90					29	31								20.00		60.00					15.00		45.00					15.00		37.50																	20.00			20.00			0.67	0.50	0.50			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	016	0	1	04	01	H5526_016_0	4	Preferred Brand	4	000001	1	2	3	1		110	10	110		1				30		90	1	2	30		90					29	31								47.00		141.00					42.00		126.00					42.00		105.00																	47.00			47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	016	0	1	04	01	H5526_016_0	4	Non-Preferred Drug	4	100100	1	2	4	1		110	10	110		1				30		90	1	2	30		90					29	31								100.00		300.00					94.00		282.00					94.00		235.00																	100.00			100.00			3.33	3.13	3.13			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	016	0	1	04	01	H5526_016_0	4	Specialty Tier	4	010010	1	1	5	1		110	10	110		1				30		90	1	2	30		90					29	31												33		33					33		33				33		33																33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	017	0	1	04	01	H5526_017_0	5	Preferred Generic	4	001000	1	2	1	1		110	10	110		1				30		90	1	2	30		90					29	31								12.00		36.00					7.00		21.00					7.00		17.50																	12.00			12.00			0.40	0.23	0.23			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	017	0	1	04	01	H5526_017_0	5	Generic	4	010000	1	2	2	1		110	10	110		1				30		90	1	2	30		90					29	31								20.00		60.00					15.00		45.00					15.00		37.50																	20.00			20.00			0.67	0.50	0.50			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	017	0	1	04	01	H5526_017_0	5	Preferred Brand	4	000001	1	2	3	1		110	10	110		1				30		90	1	2	30		90					29	31								47.00		141.00					42.00		126.00					42.00		105.00																	47.00			47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	017	0	1	04	01	H5526_017_0	5	Non-Preferred Drug	4	100100	1	2	4	1		110	10	110		1				30		90	1	2	30		90					29	31								100.00		300.00					94.00		282.00					94.00		235.00																	100.00			100.00			3.33	3.13	3.13			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	017	0	1	04	01	H5526_017_0	5	Specialty Tier	4	010010	1	1	5	1		110	10	110		1				30		90	1	2	30		90					29	31												33		33					33		33				33		33																33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	018	0	1	04	01	H5526_018_0	5	Preferred Generic	4	001000	1	2	1	1		110	10	110		1				30		90	1	2	30		90					29	31								10.00		30.00					5.00		15.00					5.00		12.50																	10.00			10.00			0.33	0.17	0.17			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	018	0	1	04	01	H5526_018_0	5	Preferred Generic	4	001000	1	2	1	3		110	10	110		1				30		90	1	2	30		90					29	31								10.00		30.00					5.00		15.00					5.00		12.50																	10.00			10.00			0.33	0.17	0.17			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5526	018	0	1	04	01	H5526_018_0	5	Generic	4	010000	1	2	2	1		110	10	110		1				30		90	1	2	30		90					29	31								20.00		60.00					15.00		45.00					15.00		37.50																	20.00			20.00			0.67	0.50	0.50			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	018	0	1	04	01	H5526_018_0	5	Preferred Brand	4	000001	1	2	3	1		110	10	110		1				30		90	1	2	30		90					29	31								40.00		120.00					35.00		105.00					35.00		87.50																	40.00			40.00			1.33	1.17	1.17			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	018	0	1	04	01	H5526_018_0	5	Non-Preferred Drug	4	100100	1	2	4	1		110	10	110		1				30		90	1	2	30		90					29	31								100.00		300.00					94.00		282.00					94.00		235.00																	100.00			100.00			3.33	3.13	3.13			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	018	0	1	04	01	H5526_018_0	5	Specialty Tier	4	010010	1	1	5	1		110	10	110		1				30		90	1	2	30		90					29	31												33		33					33		33				33		33																33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	019	0	1	04	01	H5526_019_0	8	Preferred Generic	4	001000	1	2	1	1		110	10	110		1				30		90	1	2	30		90					29	31								15.00		45.00					10.00		30.00					10.00		25.00																	15.00			15.00			0.50	0.33	0.33			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	019	0	1	04	01	H5526_019_0	8	Generic	4	010000	1	2	2	1		110	10	110		1				30		90	1	2	30		90					29	31								20.00		60.00					15.00		45.00					15.00		37.50																	20.00			20.00			0.67	0.50	0.50			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	019	0	1	04	01	H5526_019_0	8	Preferred Brand	4	000001	1	2	3	1		110	10	110		1				30		90	1	2	30		90					29	31								47.00		141.00					42.00		126.00					42.00		105.00																	47.00			47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	019	0	1	04	01	H5526_019_0	8	Non-Preferred Drug	4	100100	1	2	4	1		110	10	110		1				30		90	1	2	30		90					29	31								100.00		300.00					94.00		282.00					94.00		235.00																	100.00			100.00			3.33	3.13	3.13			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5526	019	0	1	04	01	H5526_019_0	8	Specialty Tier	4	010010	1	1	5	1		110	10	110		1				30		90	1	2	30		90					29	31												33		33					33		33				33		33																33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5530	006	1	1	04	01	H5530_006_1	9	Preferred Generic	4	001000	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												
H5530	006	1	1	04	01	H5530_006_1	9	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5530	006	1	1	04	01	H5530_006_1	9	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	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												
H5530	006	1	1	04	01	H5530_006_1	9	Non-Preferred Drug	4	100100	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								94.00	188.00	282.00					89.00	178.00	267.00					89.00	267.00	267.00																94.00				94.00			3.13	2.97	2.97			2.76	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5530	006	1	1	04	01	H5530_006_1	9	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5530	006	1	1	04	01	H5530_006_1	9	Select Care Drugs	4	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5530	006	1	1	04	01	H5530_006_1	9	Select Care Drugs	4	001000	1	2	6	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		
H5530	006	2	1	04	01	H5530_006_2	9	Preferred Generic	4	001000	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												
H5530	006	2	1	04	01	H5530_006_2	9	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5530	006	2	1	04	01	H5530_006_2	9	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	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												
H5530	006	2	1	04	01	H5530_006_2	9	Non-Preferred Drug	4	100100	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								94.00	188.00	282.00					89.00	178.00	267.00					89.00	267.00	267.00																94.00				94.00			3.13	2.97	2.97			2.76	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5530	006	2	1	04	01	H5530_006_2	9	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5530	006	2	1	04	01	H5530_006_2	9	Select Care Drugs	4	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5530	006	2	1	04	01	H5530_006_2	9	Select Care Drugs	4	001000	1	2	6	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		
H5533	003	0	1	04	01	H5533_003_0	6	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	14.00		42.00																					28.00																14.00				14.00		0.47						0.45	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5533	003	0	1	04	01	H5533_003_0	6	Preferred Brand	4	010001	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	47.00		141.00																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5533	003	0	1	04	01	H5533_003_0	6	Non-Preferred Drug	4	110000	1	2	3	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, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5533	003	0	1	04	01	H5533_003_0	6	Specialty Tier	4	010010	1	1	4	1	010		01	010		1	30								30						30		31				562.13	33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5533	003	0	1	04	01	H5533_003_0	6	Select Care Drugs	4	010000	1	2	5	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5533	005	0	1	04	01	H5533_005_0	5	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	12.00		36.00																					24.00																12.00				12.00		0.40						0.39	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5533	005	0	1	04	01	H5533_005_0	5	Preferred Brand	4	010001	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	47.00		141.00																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5533	005	0	1	04	01	H5533_005_0	5	Non-Preferred Drug	4	110000	1	2	3	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, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5533	005	0	1	04	01	H5533_005_0	5	Specialty Tier	4	010010	1	1	4	1	010		01	010		1	30								30						30		31				548.51	33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5533	005	0	1	04	01	H5533_005_0	5	Select Care Drugs	4	010000	1	2	5	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5576	017	1	1	02	01	H5576_017_1	9	Preferred Generic	4	001000	1	2	1	1	110		01		110	1	31		90				1	2				31		90	31		31	4.00		12.00																									4.00		12.00				0.00		0.00				4.00				4.00		0.13				0.13	0.00	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	017	1	1	02	01	H5576_017_1	9	Generic	4	010000	1	2	2	1	110		01		100	1	31		90				1	2						90	31		31	10.00		30.00																											30.00						30.00				10.00				10.00		0.32						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	017	1	1	02	01	H5576_017_1	9	Preferred Brand	4	000001	1	2	3	1	110		01		100	1	31		90				1	2						90	31		31	47.00		141.00																											141.00						141.00				47.00				47.00		1.52						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	017	1	1	02	01	H5576_017_1	9	Non-Preferred Brand	4	100000	1	2	4	1	110		01		100	1	31		90				1	2						90	31		31	100.00		300.00																											300.00						300.00				100.00				100.00		3.23						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	017	1	1	02	01	H5576_017_1	9	Specialty Tier	4	100000	1	1	5	1	010		01			1	31														31		31				1510.86	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	017	2	1	02	01	H5576_017_2	9	Preferred Generic	4	001000	1	2	1	1	110		01		110	1	31		90				1	2				31		90	31		31	4.00		12.00																									4.00		12.00				0.00		0.00				4.00				4.00		0.13				0.13	0.00	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	017	2	1	02	01	H5576_017_2	9	Generic	4	010000	1	2	2	1	110		01		100	1	31		90				1	2						90	31		31	10.00		30.00																											30.00						30.00				10.00				10.00		0.32						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	017	2	1	02	01	H5576_017_2	9	Preferred Brand	4	000001	1	2	3	1	110		01		100	1	31		90				1	2						90	31		31	47.00		141.00																											141.00						141.00				47.00				47.00		1.52						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	017	2	1	02	01	H5576_017_2	9	Non-Preferred Brand	4	100000	1	2	4	1	110		01		100	1	31		90				1	2						90	31		31	100.00		300.00																											300.00						300.00				100.00				100.00		3.23						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	017	2	1	02	01	H5576_017_2	9	Specialty Tier	4	100000	1	1	5	1	010		01			1	31														31		31				1510.86	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	018	1	1	02	01	H5576_018_1	9	Preferred Generic	4	001000	1	2	1	1	110		01		110	1	31		90				1	2				31		90	31		31	4.00		12.00																									4.00		12.00				0.00		0.00				4.00				4.00		0.13				0.13	0.00	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	018	1	1	02	01	H5576_018_1	9	Preferred Generic	4	001000	1	2	1	3	110		01		110	1	31		90				1	2				31		90	31		31	4.00		12.00																									4.00		12.00				0.00		0.00				4.00				4.00		0.13				0.13	0.00	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5576	018	1	1	02	01	H5576_018_1	9	Generic	4	010000	1	2	2	1	110		01		100	1	31		90				1	2						90	31		31	10.00		30.00																											30.00						30.00				10.00				10.00		0.32						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	018	1	1	02	01	H5576_018_1	9	Preferred Brand	4	000001	1	2	3	1	110		01		100	1	31		90				1	2						90	31		31	47.00		141.00																											141.00						141.00				47.00				47.00		1.52						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	018	1	1	02	01	H5576_018_1	9	Non-Preferred Brand	4	100000	1	2	4	1	110		01		100	1	31		90				1	2						90	31		31	100.00		300.00																											300.00						300.00				100.00				100.00		3.23						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	018	1	1	02	01	H5576_018_1	9	Specialty Tier	4	100000	1	1	5	1	010		01			1	31														31		31				1463.22	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	018	2	1	02	01	H5576_018_2	9	Preferred Generic	4	001000	1	2	1	1	110		01		110	1	31		90				1	2				31		90	31		31	4.00		12.00																									4.00		12.00				0.00		0.00				4.00				4.00		0.13				0.13	0.00	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	018	2	1	02	01	H5576_018_2	9	Preferred Generic	4	001000	1	2	1	3	110		01		110	1	31		90				1	2				31		90	31		31	4.00		12.00																									4.00		12.00				0.00		0.00				4.00				4.00		0.13				0.13	0.00	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5576	018	2	1	02	01	H5576_018_2	9	Generic	4	010000	1	2	2	1	110		01		100	1	31		90				1	2						90	31		31	10.00		30.00																											30.00						30.00				10.00				10.00		0.32						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	018	2	1	02	01	H5576_018_2	9	Preferred Brand	4	000001	1	2	3	1	110		01		100	1	31		90				1	2						90	31		31	47.00		141.00																											141.00						141.00				47.00				47.00		1.52						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	018	2	1	02	01	H5576_018_2	9	Non-Preferred Brand	4	100000	1	2	4	1	110		01		100	1	31		90				1	2						90	31		31	100.00		300.00																											300.00						300.00				100.00				100.00		3.23						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	018	2	1	02	01	H5576_018_2	9	Specialty Tier	4	100000	1	1	5	1	010		01			1	31														31		31				1463.22	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	020	1	1	02	01	H5576_020_1	9	Preferred Generic	4	001000	1	2	1	1	110		01		110	1	31		90				1	2				31		90	31		31	4.00		12.00																									4.00		12.00				0.00		0.00				4.00				4.00		0.13				0.13	0.00	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	020	1	1	02	01	H5576_020_1	9	Generic	4	010000	1	2	2	1	110		01		100	1	31		90				1	2						90	31		31	10.00		30.00																											30.00						30.00				10.00				10.00		0.32						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	020	1	1	02	01	H5576_020_1	9	Preferred Brand	4	000001	1	1	3	1	110		01		100	1	31		90				1	2						90	31		31				97.41	25		25																										25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	020	1	1	02	01	H5576_020_1	9	Non-Preferred Brand	4	100000	1	1	4	1	110		01		100	1	31		90				1	2						90	31		31				72.19	25		25																										25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	020	1	1	02	01	H5576_020_1	9	Specialty Tier	4	100000	1	1	5	1	010		01			1	31														31		31				1215.78	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	020	2	1	02	01	H5576_020_2	9	Preferred Generic	4	001000	1	2	1	1	110		01		110	1	31		90				1	2				31		90	31		31	4.00		12.00																									4.00		12.00				0.00		0.00				4.00				4.00		0.13				0.13	0.00	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	020	2	1	02	01	H5576_020_2	9	Generic	4	010000	1	2	2	1	110		01		100	1	31		90				1	2						90	31		31	10.00		30.00																											30.00						30.00				10.00				10.00		0.32						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	020	2	1	02	01	H5576_020_2	9	Preferred Brand	4	000001	1	1	3	1	110		01		100	1	31		90				1	2						90	31		31				97.41	25		25																										25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	020	2	1	02	01	H5576_020_2	9	Non-Preferred Brand	4	100000	1	1	4	1	110		01		100	1	31		90				1	2						90	31		31				72.19	25		25																										25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	020	2	1	02	01	H5576_020_2	9	Specialty Tier	4	100000	1	1	5	1	010		01			1	31														31		31				1215.78	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	021	1	1	02	01	H5576_021_1	9	Preferred Generic	4	001000	1	2	1	1	110		01		110	1	31		90				1	2				31		90	31		31	4.00		12.00																									4.00		12.00				0.00		0.00				4.00				4.00		0.13				0.13	0.00	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	021	1	1	02	01	H5576_021_1	9	Generic	4	010000	1	2	2	1	110		01		100	1	31		90				1	2						90	31		31	10.00		30.00																											30.00						30.00				10.00				10.00		0.32						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	021	1	1	02	01	H5576_021_1	9	Preferred Brand	4	000001	1	1	3	1	110		01		100	1	31		90				1	2						90	31		31				93.54	25		25																										25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	021	1	1	02	01	H5576_021_1	9	Non-Preferred Brand	4	100000	1	1	4	1	110		01		100	1	31		90				1	2						90	31		31				79.05	25		25																										25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	021	1	1	02	01	H5576_021_1	9	Specialty Tier	4	100000	1	1	5	1	010		01			1	31														31		31				1216.85	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	021	2	1	02	01	H5576_021_2	9	Preferred Generic	4	001000	1	2	1	1	110		01		110	1	31		90				1	2				31		90	31		31	4.00		12.00																									4.00		12.00				0.00		0.00				4.00				4.00		0.13				0.13	0.00	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	021	2	1	02	01	H5576_021_2	9	Generic	4	010000	1	2	2	1	110		01		100	1	31		90				1	2						90	31		31	10.00		30.00																											30.00						30.00				10.00				10.00		0.32						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	021	2	1	02	01	H5576_021_2	9	Preferred Brand	4	000001	1	1	3	1	110		01		100	1	31		90				1	2						90	31		31				93.54	25		25																										25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	021	2	1	02	01	H5576_021_2	9	Non-Preferred Brand	4	100000	1	1	4	1	110		01		100	1	31		90				1	2						90	31		31				79.05	25		25																										25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5576	021	2	1	02	01	H5576_021_2	9	Specialty Tier	4	100000	1	1	5	1	010		01			1	31														31		31				1216.85	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5577	005	0	1	01	01	H5577_005_0	4	Preferred Generic	4	001000	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 Brand, Specialty Tier, Select Care Drugs												
H5577	005	0	1	01	01	H5577_005_0	4	Preferred Generic	4	001000	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5577	005	0	1	01	01	H5577_005_0	4	Generic	4	010000	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 Brand, Specialty Tier, Select Care Drugs												
H5577	005	0	1	01	01	H5577_005_0	4	Generic	4	010000	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	8.00	16.00	24.00																			8.00	16.00	16.00																8.00				8.00		0.27			0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5577	005	0	1	01	01	H5577_005_0	4	Preferred Brand	4	000001	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	70.00																35.00				35.00		1.17			1.17			1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5577	005	0	1	01	01	H5577_005_0	4	Non-Preferred Brand	4	100000	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	55.00	110.00	165.00																			55.00	110.00	110.00																55.00				55.00		1.83			1.83			1.77	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5577	005	0	1	01	01	H5577_005_0	4	Specialty Tier	4	101101	1	1	5	1	010		01	010		1	30								30						30		31				1949.19	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5577	005	0	1	01	01	H5577_005_0	4	Select Care Drugs	4	001100	1	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	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5577	005	0	1	01	01	H5577_005_0	4	Select Care Drugs	4	001100	1	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	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5577	008	0	1	02	01	H5577_008_0	6	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	15.00																			5.00	10.00	10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5577	008	0	1	02	01	H5577_008_0	6	Preferred Generic	4	001000	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	15.00																			5.00	10.00	10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5577	008	0	1	02	01	H5577_008_0	6	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5577	008	0	1	02	01	H5577_008_0	6	Generic	4	010000	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5577	008	0	1	02	01	H5577_008_0	6	Preferred Brand	4	000001	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	40.00	80.00	120.00																			40.00	80.00	80.00																40.00				40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5577	008	0	1	02	01	H5577_008_0	6	Non-Preferred Brand	4	100000	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	65.00	130.00	195.00																			65.00	130.00	130.00																65.00				65.00		2.17			2.17			2.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5577	008	0	1	02	01	H5577_008_0	6	Specialty Tier	4	101101	1	1	5	1	010		01	010		1	30								30						30		31				1679.25	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5577	008	0	1	02	01	H5577_008_0	6	Select Care Drugs	4	001100	1	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	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H5577	008	0	1	02	01	H5577_008_0	6	Select Care Drugs	4	001100	1	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	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H5591	001	0	1	02	01	H5591_001_0	12	Preferred Generic	4	001001	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								4.00	8.00	12.00					0.00	0.00	0.00					4.00	8.00	10.00																4.00				4.00			0.13	0.00	0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	001	0	1	02	01	H5591_001_0	12	Generic	4	010001	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					10.00	20.00	30.00					18.00	36.00	45.00																18.00				18.00			0.60	0.33	0.60			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	001	0	1	02	01	H5591_001_0	12	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					40.00	80.00	120.00					47.00	94.00	117.50																47.00				47.00			1.57	1.33	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	001	0	1	02	01	H5591_001_0	12	Non-Preferred Drug	4	100100	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00	200.00	250.00																100.00				100.00			3.33	3.17	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	001	0	1	02	01	H5591_001_0	12	Specialty Tier	4	000010	1	1	5	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											600.00	33	33	33				600.00	33	33	33				33	33	33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5591	005	0	1	02	01	H5591_005_0	11	Preferred Generic	4	001001	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	11	Generic	4	010001	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	11	Preferred Brand	4	000101	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	11	Non-Preferred Drug	4	100100	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	11	Specialty Tier	4	000010	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	13	Preferred Generic	4	001001	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	13	Generic	4	010001	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	13	Preferred Brand	4	000101	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	13	Non-Preferred Drug	4	100100	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	13	Specialty Tier	4	000010	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	13	Preferred Generic	4	001001	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	13	Generic	4	010001	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	13	Preferred Brand	4	000101	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	13	Non-Preferred Drug	4	100100	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	13	Specialty Tier	4	000010	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	3	1	02	01	H5591_006_3	14	Preferred Generic	4	001001	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	3	1	02	01	H5591_006_3	14	Generic	4	010001	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	3	1	02	01	H5591_006_3	14	Preferred Brand	4	000101	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	3	1	02	01	H5591_006_3	14	Non-Preferred Drug	4	100100	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	3	1	02	01	H5591_006_3	14	Specialty Tier	4	000010	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	11	Preferred Generic	4	001001	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	11	Preferred Generic	4	001001	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	11	Generic	4	010001	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	11	Generic	4	010001	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	11	Preferred Brand	4	000101	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	11	Non-Preferred Drug	4	100100	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	11	Specialty Tier	4	000010	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	008	0	1	01	01	H5591_008_0	11	Preferred Generic	4	001001	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	008	0	1	01	01	H5591_008_0	11	Generic	4	010001	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	008	0	1	01	01	H5591_008_0	11	Preferred Brand	4	000101	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	008	0	1	01	01	H5591_008_0	11	Non-Preferred Drug	4	100100	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	008	0	1	01	01	H5591_008_0	11	Specialty Tier	4	000010	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	11	Preferred Generic	4	001001	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	11	Generic	4	010001	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	11	Preferred Brand	4	000101	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	11	Non-Preferred Drug	4	100100	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	11	Specialty Tier	4	000010	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	10	Preferred Generic	4	001000	3	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	001	0	1	01	01	H5594_001_0	10	Preferred Generic	4	001000	3	2	1	3	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5594	001	0	1	01	01	H5594_001_0	10	Preferred Brand	4	000101	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	35.00		105.00																			35.00		70.00																35.00				35.00		1.17			1.17			1.13	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	001	0	1	01	01	H5594_001_0	10	Non-Preferred Drug	4	100100	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	85.00		255.00																			85.00		170.00																85.00				85.00		2.83			2.83			2.74	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	001	0	1	01	01	H5594_001_0	10	Specialty Tier	4	100100	1	1	4	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	002	0	1	01	01	H5594_002_0	10	Preferred Generic	4	001000	3	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	002	0	1	01	01	H5594_002_0	10	Preferred Generic	4	001000	3	2	1	3	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5594	002	0	1	01	01	H5594_002_0	10	Preferred Brand	4	000101	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, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	002	0	1	01	01	H5594_002_0	10	Non-Preferred Drug	4	100100	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	69.00		207.00																			69.00		138.00																69.00				69.00		2.30			2.30			2.23	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	002	0	1	01	01	H5594_002_0	10	Specialty Tier	4	100100	1	1	4	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	016	0	1	01	01	H5594_016_0	9	Preferred Generic	4	001000	3	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	016	0	1	01	01	H5594_016_0	9	Preferred Brand	4	000101	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	45.00		135.00																			45.00		135.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	016	0	1	01	01	H5594_016_0	9	Non-Preferred Drug	4	100100	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	95.00		285.00																			95.00		285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	016	0	1	01	01	H5594_016_0	9	Specialty Tier	4	100100	1	1	4	1	010		01	010		1	30								30						30		31					25																				25																	25			25								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	017	0	1	01	01	H5594_017_0	8	Preferred Generic	4	001000	3	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	017	0	1	01	01	H5594_017_0	8	Preferred Brand	4	000101	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	45.00		135.00																			45.00		135.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	017	0	1	01	01	H5594_017_0	8	Non-Preferred Drug	4	100100	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	95.00		285.00																			95.00		285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	017	0	1	01	01	H5594_017_0	8	Specialty Tier	4	100100	1	1	4	1	010		01	010		1	30								30						30		31					25																				25																	25			25								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	019	0	1	01	01	H5594_019_0	9	Preferred Generic	4	001000	3	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	019	0	1	01	01	H5594_019_0	9	Preferred Generic	4	001000	3	2	1	3	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5594	019	0	1	01	01	H5594_019_0	9	Preferred Brand	4	000101	1	2	2	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, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	019	0	1	01	01	H5594_019_0	9	Non-Preferred Drug	4	100100	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	85.00		255.00																			85.00		170.00																85.00				85.00		2.83			2.83			2.74	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	019	0	1	01	01	H5594_019_0	9	Specialty Tier	4	100100	1	1	4	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	022	0	1	01	01	H5594_022_0	9	Preferred Generic	4	001000	3	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	022	0	1	01	01	H5594_022_0	9	Preferred Generic	4	001000	3	2	1	3	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5594	022	0	1	01	01	H5594_022_0	9	Preferred Brand	4	000101	1	2	2	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, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	022	0	1	01	01	H5594_022_0	9	Non-Preferred Drug	4	100100	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	95.00		285.00																			95.00		190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	022	0	1	01	01	H5594_022_0	9	Specialty Tier	4	100100	1	1	4	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	026	0	1	01	01	H5594_026_0	9	Preferred Generic	4	001000	3	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	026	0	1	01	01	H5594_026_0	9	Preferred Generic	4	001000	3	2	1	3	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5594	026	0	1	01	01	H5594_026_0	9	Preferred Brand	4	000101	1	2	2	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, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	026	0	1	01	01	H5594_026_0	9	Non-Preferred Drug	4	100100	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	95.00		285.00																			95.00		190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	026	0	1	01	01	H5594_026_0	9	Specialty Tier	4	100100	1	1	4	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	028	0	1	01	01	H5594_028_0	9	Preferred Generic	4	001000	3	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5594	028	0	1	01	01	H5594_028_0	9	Preferred Generic	4	001000	3	2	1	3	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs										1		3
H5594	028	0	1	01	01	H5594_028_0	9	Preferred Brand	4	000101	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	20.00		60.00																			20.00		40.00																20.00				20.00		0.67			0.67			0.65	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5594	028	0	1	01	01	H5594_028_0	9	Non-Preferred Drug	4	100100	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	60.00		180.00																			60.00		120.00																60.00				60.00		2.00			2.00			1.94	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5594	028	0	1	01	01	H5594_028_0	9	Specialty Tier	4	100100	1	1	4	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5594	028	0	1	01	01	H5594_028_0	9	Select Diabetic Drugs	4	000010	1	2	5	1	110		01	110		1	30		90				1	2	30		90				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5594	029	0	1	01	01	H5594_029_0	8	Preferred Generic	4	001000	3	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	029	0	1	01	01	H5594_029_0	8	Preferred Generic	4	001000	3	2	1	3	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5594	029	0	1	01	01	H5594_029_0	8	Preferred Brand	4	000101	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	25.00		75.00																			25.00		50.00																25.00				25.00		0.83			0.83			0.81	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	029	0	1	01	01	H5594_029_0	8	Non-Preferred Drug	4	100100	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	69.00		207.00																			69.00		138.00																69.00				69.00		2.30			2.30			2.23	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	029	0	1	01	01	H5594_029_0	8	Specialty Tier	4	100100	1	1	4	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	030	0	1	01	01	H5594_030_0	9	Preferred Generic	4	001000	3	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5594	030	0	1	01	01	H5594_030_0	9	Preferred Generic	4	001000	3	2	1	3	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs										1		3
H5594	030	0	1	01	01	H5594_030_0	9	Preferred Brand	4	000101	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	35.00		105.00																			35.00		70.00																35.00				35.00		1.17			1.17			1.13	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5594	030	0	1	01	01	H5594_030_0	9	Non-Preferred Drug	4	100100	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	80.00		240.00																			80.00		160.00																80.00				80.00		2.67			2.67			2.58	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5594	030	0	1	01	01	H5594_030_0	9	Specialty Tier	4	100100	1	1	4	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5594	030	0	1	01	01	H5594_030_0	9	Select Diabetic Drugs	4	000010	1	2	5	1	110		01	110		1	30		90				1	2	30		90				30		31	10.00		30.00																			10.00		20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Diabetic Drugs												
H5594	031	0	1	01	01	H5594_031_0	8	Preferred Generic	4	001000	3	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	031	0	1	01	01	H5594_031_0	8	Preferred Generic	4	001000	3	2	1	3	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5594	031	0	1	01	01	H5594_031_0	8	Preferred Brand	4	000101	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	35.00		105.00																			35.00		70.00																35.00				35.00		1.17			1.17			1.13	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	031	0	1	01	01	H5594_031_0	8	Non-Preferred Drug	4	100100	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	80.00		240.00																			80.00		160.00																80.00				80.00		2.67			2.67			2.58	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	031	0	1	01	01	H5594_031_0	8	Specialty Tier	4	100100	1	1	4	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	032	0	1	01	01	H5594_032_0	9	Preferred Generic	4	001000	3	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	032	0	1	01	01	H5594_032_0	9	Preferred Generic	4	001000	3	2	1	3	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5594	032	0	1	01	01	H5594_032_0	9	Preferred Brand	4	000101	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	25.00		75.00																			25.00		50.00																25.00				25.00		0.83			0.83			0.81	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	032	0	1	01	01	H5594_032_0	9	Non-Preferred Drug	4	100100	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	60.00		180.00																			60.00		120.00																60.00				60.00		2.00			2.00			1.94	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	032	0	1	01	01	H5594_032_0	9	Specialty Tier	4	100100	1	1	4	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	034	0	1	01	01	H5594_034_0	9	Preferred Generic	4	001000	3	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	034	0	1	01	01	H5594_034_0	9	Preferred Generic	4	001000	3	2	1	3	110		01	110		1	30		90				2	2	30		90				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5594	034	0	1	01	01	H5594_034_0	9	Preferred Brand	4	000101	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	35.00		105.00																			35.00		70.00																35.00				35.00		1.17			1.17			1.13	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	034	0	1	01	01	H5594_034_0	9	Non-Preferred Drug	4	100100	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	80.00		240.00																			80.00		160.00																80.00				80.00		2.67			2.67			2.58	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	034	0	1	01	01	H5594_034_0	9	Specialty Tier	4	100100	1	1	4	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	035	0	1	01	01	H5594_035_0	10	Preferred Generic	4	001000	3	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	035	0	1	01	01	H5594_035_0	10	Preferred Generic	4	001000	3	2	1	3	110		01	110		1	30		90				2	2	30		90				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		3
H5594	035	0	1	01	01	H5594_035_0	10	Preferred Brand	4	000101	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	35.00		105.00																			35.00		70.00																35.00				35.00		1.17			1.17			1.13	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	035	0	1	01	01	H5594_035_0	10	Non-Preferred Drug	4	100100	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	80.00		240.00																			80.00		160.00																80.00				80.00		2.67			2.67			2.58	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5594	035	0	1	01	01	H5594_035_0	10	Specialty Tier	4	100100	1	1	4	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5608	002	0	1	01	01	H5608_002_0	13	Preferred Generic	3	001000	1	2	1	1	110		10	100		1	30		90				1	2			90					10	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												
H5608	002	0	1	01	01	H5608_002_0	13	Generic	3	010000	1	2	2	1	110		10	100		1	30		90				1	2			90					10	31	10.00		20.00																					20.00																	10.00			10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5608	002	0	1	01	01	H5608_002_0	13	Preferred Brand	3	000001	1	1	3	1	110		10	100		1	30		90				1	2			90					10	31				20.73	25		25																				25																25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5608	002	0	1	01	01	H5608_002_0	13	Non-Preferred Brand	3	100000	1	1	4	1	110		10	100		1	30		90				1	2			90					10	31				51.41	50		50																				50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5608	002	0	1	01	01	H5608_002_0	13	Specialty Tier	3	000010	1	1	5	1	010		10	010		1	30								30							10	31				311.28	26																				26																		26		26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5609	001	0	1	01	01	H5609_001_0	5	Preferred Generic	4	001010	1	2	1	1		111	01	100		1				30	60	90	1	2			90				30		31								10.00	20.00	30.00					5.00	10.00	10.00							10.00																10.00				10.00			0.33	0.17				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H5609	001	0	1	01	01	H5609_001_0	5	Generic	4	010010	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	30.00							30.00																20.00				20.00			0.67	0.50				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H5609	001	0	1	01	01	H5609_001_0	5	Preferred Brand	4	010001	1	2	3	1		111	01	100		1				30	60	90	2	2			90				30		31								47.00	94.00	141.00					40.00	80.00	80.00							80.00																47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H5609	001	0	1	01	01	H5609_001_0	5	Non-Preferred Brand	4	110000	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	190.00							190.00																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H5609	001	0	1	01	01	H5609_001_0	5	Injectable Drugs	4	010010	1	1	5	1		111	01	100		1				30	60	90	2	2			90				30		31											67.58	33	33	33				67.58	33	33	33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H5609	001	0	1	01	01	H5609_001_0	5	Specialty Tier	4	010010	1	1	6	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H5609	004	0	1	01	01	H5609_004_0	5	Preferred Generic	4	001010	1	2	1	1		111	01	100		1				30	60	90	1	2			90				30		31								10.00	20.00	30.00					5.00	10.00	10.00							10.00																10.00				10.00			0.33	0.17				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H5609	004	0	1	01	01	H5609_004_0	5	Preferred Generic	4	001010	1	2	1	3		111	01	100		1				30	60	90	1	2			90				30		31								10.00	20.00	30.00					5.00	10.00	10.00							10.00																10.00				10.00			0.33	0.17				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier										1		
H5609	004	0	1	01	01	H5609_004_0	5	Generic	4	010010	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	30.00							30.00																20.00				20.00			0.67	0.50				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H5609	004	0	1	01	01	H5609_004_0	5	Preferred Brand	4	010001	1	2	3	1		111	01	100		1				30	60	90	2	2			90				30		31								47.00	94.00	141.00					40.00	80.00	80.00							80.00																47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H5609	004	0	1	01	01	H5609_004_0	5	Non-Preferred Brand	4	110000	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	190.00							190.00																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H5609	004	0	1	01	01	H5609_004_0	5	Injectable Drugs	4	010010	1	1	5	1		111	01	100		1				30	60	90	2	2			90				30		31											79.95	33	33	33				79.95	33	33	33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H5609	004	0	1	01	01	H5609_004_0	5	Specialty Tier	4	010010	1	1	6	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H5619	001	0	1	01	01	H5619_001_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					8.00		24.00											10.00		30.00				8.00		0.00				10.00				10.00			0.33	0.27		0.33	0.27	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	001	0	1	01	01	H5619_001_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					8.00		24.00											10.00		30.00				8.00		0.00				10.00				10.00			0.33	0.27		0.33	0.27	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5619	001	0	1	01	01	H5619_001_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					18.00		54.00											20.00		60.00				18.00		0.00				20.00				20.00			0.67	0.60		0.67	0.60	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	001	0	1	01	01	H5619_001_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					18.00		54.00											20.00		60.00				18.00		0.00				20.00				20.00			0.67	0.60		0.67	0.60	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5619	001	0	1	01	01	H5619_001_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	001	0	1	01	01	H5619_001_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5619	001	0	1	01	01	H5619_001_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	001	0	1	01	01	H5619_001_0	4	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5619	001	0	1	01	01	H5619_001_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	001	0	1	01	01	H5619_001_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5619	003	0	1	01	01	H5619_003_0	4	Preferred Generic	3	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	003	0	1	01	01	H5619_003_0	4	Generic	3	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								17.00		51.00					12.00		36.00											17.00		51.00				12.00		0.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	003	0	1	01	01	H5619_003_0	4	Preferred Brand	3	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	003	0	1	01	01	H5619_003_0	4	Non-Preferred Drug	3	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	003	0	1	01	01	H5619_003_0	4	Specialty Tier	3	010010	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	012	0	1	01	01	H5619_012_0	5	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	012	0	1	01	01	H5619_012_0	5	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5619	012	0	1	01	01	H5619_012_0	5	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	012	0	1	01	01	H5619_012_0	5	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5619	012	0	1	01	01	H5619_012_0	5	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	012	0	1	01	01	H5619_012_0	5	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5619	012	0	1	01	01	H5619_012_0	5	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	012	0	1	01	01	H5619_012_0	5	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5619	012	0	1	01	01	H5619_012_0	5	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	012	0	1	01	01	H5619_012_0	5	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5619	013	0	1	01	01	H5619_013_0	5	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	013	0	1	01	01	H5619_013_0	5	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5619	013	0	1	01	01	H5619_013_0	5	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	013	0	1	01	01	H5619_013_0	5	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5619	013	0	1	01	01	H5619_013_0	5	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	013	0	1	01	01	H5619_013_0	5	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5619	013	0	1	01	01	H5619_013_0	5	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	013	0	1	01	01	H5619_013_0	5	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5619	013	0	1	01	01	H5619_013_0	5	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	013	0	1	01	01	H5619_013_0	5	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5619	015	0	1	01	01	H5619_015_0	5	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	015	0	1	01	01	H5619_015_0	5	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5619	015	0	1	01	01	H5619_015_0	5	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	015	0	1	01	01	H5619_015_0	5	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5619	015	0	1	01	01	H5619_015_0	5	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	015	0	1	01	01	H5619_015_0	5	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5619	015	0	1	01	01	H5619_015_0	5	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	015	0	1	01	01	H5619_015_0	5	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5619	015	0	1	01	01	H5619_015_0	5	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	015	0	1	01	01	H5619_015_0	5	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5619	016	0	1	01	01	H5619_016_0	5	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	016	0	1	01	01	H5619_016_0	5	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5619	016	0	1	01	01	H5619_016_0	5	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	016	0	1	01	01	H5619_016_0	5	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5619	016	0	1	01	01	H5619_016_0	5	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	016	0	1	01	01	H5619_016_0	5	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5619	016	0	1	01	01	H5619_016_0	5	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	016	0	1	01	01	H5619_016_0	5	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5619	016	0	1	01	01	H5619_016_0	5	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	016	0	1	01	01	H5619_016_0	5	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5619	021	0	1	01	01	H5619_021_0	5	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	021	0	1	01	01	H5619_021_0	5	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5619	021	0	1	01	01	H5619_021_0	5	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								15.00		45.00					10.00		30.00											15.00		45.00				10.00		0.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	021	0	1	01	01	H5619_021_0	5	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								15.00		45.00					10.00		30.00											15.00		45.00				10.00		0.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5619	021	0	1	01	01	H5619_021_0	5	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								40.00		120.00					35.00		105.00											40.00		120.00				35.00		70.00				40.00				40.00			1.33	1.17		1.33	1.17	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	021	0	1	01	01	H5619_021_0	5	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								40.00		120.00					35.00		105.00											40.00		120.00				35.00		70.00				40.00				40.00			1.33	1.17		1.33	1.17	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5619	021	0	1	01	01	H5619_021_0	5	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		200.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	021	0	1	01	01	H5619_021_0	5	Non-Preferred Drug	4	110000	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		300.00				100.00		200.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5619	021	0	1	01	01	H5619_021_0	5	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	021	0	1	01	01	H5619_021_0	5	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5619	023	0	1	01	01	H5619_023_0	5	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	023	0	1	01	01	H5619_023_0	5	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5619	023	0	1	01	01	H5619_023_0	5	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	023	0	1	01	01	H5619_023_0	5	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5619	023	0	1	01	01	H5619_023_0	5	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	023	0	1	01	01	H5619_023_0	5	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5619	023	0	1	01	01	H5619_023_0	5	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	023	0	1	01	01	H5619_023_0	5	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5619	023	0	1	01	01	H5619_023_0	5	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	023	0	1	01	01	H5619_023_0	5	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5619	026	0	1	01	01	H5619_026_0	5	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								9.00		27.00					4.00		12.00											9.00		27.00				4.00		0.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	026	0	1	01	01	H5619_026_0	5	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								9.00		27.00					4.00		12.00											9.00		27.00				4.00		0.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5619	026	0	1	01	01	H5619_026_0	5	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	026	0	1	01	01	H5619_026_0	5	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5619	026	0	1	01	01	H5619_026_0	5	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	026	0	1	01	01	H5619_026_0	5	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5619	026	0	1	01	01	H5619_026_0	5	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	026	0	1	01	01	H5619_026_0	5	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5619	026	0	1	01	01	H5619_026_0	5	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	026	0	1	01	01	H5619_026_0	5	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5619	029	0	1	01	01	H5619_029_0	5	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								9.00		27.00					4.00		12.00											9.00		27.00				4.00		0.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	029	0	1	01	01	H5619_029_0	5	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								9.00		27.00					4.00		12.00											9.00		27.00				4.00		0.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5619	029	0	1	01	01	H5619_029_0	5	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								15.00		45.00					10.00		30.00											15.00		45.00				10.00		0.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	029	0	1	01	01	H5619_029_0	5	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								15.00		45.00					10.00		30.00											15.00		45.00				10.00		0.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5619	029	0	1	01	01	H5619_029_0	5	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	029	0	1	01	01	H5619_029_0	5	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5619	029	0	1	01	01	H5619_029_0	5	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	029	0	1	01	01	H5619_029_0	5	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5619	029	0	1	01	01	H5619_029_0	5	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	029	0	1	01	01	H5619_029_0	5	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5619	032	0	1	01	01	H5619_032_0	5	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								8.00		24.00					3.00		9.00											8.00		24.00				3.00		0.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	032	0	1	01	01	H5619_032_0	5	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								8.00		24.00					3.00		9.00											8.00		24.00				3.00		0.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5619	032	0	1	01	01	H5619_032_0	5	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	032	0	1	01	01	H5619_032_0	5	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5619	032	0	1	01	01	H5619_032_0	5	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	032	0	1	01	01	H5619_032_0	5	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5619	032	0	1	01	01	H5619_032_0	5	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	032	0	1	01	01	H5619_032_0	5	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5619	032	0	1	01	01	H5619_032_0	5	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	032	0	1	01	01	H5619_032_0	5	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5619	037	0	1	01	01	H5619_037_0	6	Preferred Generic	3	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	037	0	1	01	01	H5619_037_0	6	Generic	3	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	037	0	1	01	01	H5619_037_0	6	Preferred Brand	3	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	037	0	1	01	01	H5619_037_0	6	Non-Preferred Drug	3	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	037	0	1	01	01	H5619_037_0	6	Specialty Tier	3	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	038	0	1	01	01	H5619_038_0	7	Preferred Generic	3	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	038	0	1	01	01	H5619_038_0	7	Generic	3	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								17.00		51.00					12.00		36.00											17.00		51.00				12.00		0.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	038	0	1	01	01	H5619_038_0	7	Preferred Brand	3	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	038	0	1	01	01	H5619_038_0	7	Non-Preferred Drug	3	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	038	0	1	01	01	H5619_038_0	7	Specialty Tier	3	010010	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	039	1	1	01	01	H5619_039_1	5	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								8.00		24.00					3.00		9.00											8.00		24.00				3.00		0.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	039	1	1	01	01	H5619_039_1	5	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								8.00		24.00					3.00		9.00											8.00		24.00				3.00		0.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5619	039	1	1	01	01	H5619_039_1	5	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								15.00		45.00					10.00		30.00											15.00		45.00				10.00		0.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	039	1	1	01	01	H5619_039_1	5	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								15.00		45.00					10.00		30.00											15.00		45.00				10.00		0.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5619	039	1	1	01	01	H5619_039_1	5	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	039	1	1	01	01	H5619_039_1	5	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5619	039	1	1	01	01	H5619_039_1	5	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	039	1	1	01	01	H5619_039_1	5	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5619	039	1	1	01	01	H5619_039_1	5	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	039	1	1	01	01	H5619_039_1	5	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5619	039	2	1	01	01	H5619_039_2	5	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								8.00		24.00					3.00		9.00											8.00		24.00				3.00		0.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	039	2	1	01	01	H5619_039_2	5	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								8.00		24.00					3.00		9.00											8.00		24.00				3.00		0.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5619	039	2	1	01	01	H5619_039_2	5	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								15.00		45.00					10.00		30.00											15.00		45.00				10.00		0.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	039	2	1	01	01	H5619_039_2	5	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								15.00		45.00					10.00		30.00											15.00		45.00				10.00		0.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5619	039	2	1	01	01	H5619_039_2	5	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	039	2	1	01	01	H5619_039_2	5	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5619	039	2	1	01	01	H5619_039_2	5	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	039	2	1	01	01	H5619_039_2	5	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5619	039	2	1	01	01	H5619_039_2	5	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	039	2	1	01	01	H5619_039_2	5	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5619	040	1	1	01	01	H5619_040_1	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					8.00		24.00											10.00		30.00				8.00		0.00				10.00				10.00			0.33	0.27		0.33	0.27	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	040	1	1	01	01	H5619_040_1	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					8.00		24.00											10.00		30.00				8.00		0.00				10.00				10.00			0.33	0.27		0.33	0.27	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5619	040	1	1	01	01	H5619_040_1	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					18.00		54.00											20.00		60.00				18.00		0.00				20.00				20.00			0.67	0.60		0.67	0.60	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	040	1	1	01	01	H5619_040_1	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					18.00		54.00											20.00		60.00				18.00		0.00				20.00				20.00			0.67	0.60		0.67	0.60	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5619	040	1	1	01	01	H5619_040_1	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	040	1	1	01	01	H5619_040_1	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5619	040	1	1	01	01	H5619_040_1	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	040	1	1	01	01	H5619_040_1	4	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5619	040	1	1	01	01	H5619_040_1	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	040	1	1	01	01	H5619_040_1	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5619	040	2	1	01	01	H5619_040_2	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					8.00		24.00											10.00		30.00				8.00		0.00				10.00				10.00			0.33	0.27		0.33	0.27	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	040	2	1	01	01	H5619_040_2	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					8.00		24.00											10.00		30.00				8.00		0.00				10.00				10.00			0.33	0.27		0.33	0.27	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5619	040	2	1	01	01	H5619_040_2	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					18.00		54.00											20.00		60.00				18.00		0.00				20.00				20.00			0.67	0.60		0.67	0.60	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	040	2	1	01	01	H5619_040_2	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					18.00		54.00											20.00		60.00				18.00		0.00				20.00				20.00			0.67	0.60		0.67	0.60	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5619	040	2	1	01	01	H5619_040_2	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	040	2	1	01	01	H5619_040_2	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5619	040	2	1	01	01	H5619_040_2	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	040	2	1	01	01	H5619_040_2	4	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5619	040	2	1	01	01	H5619_040_2	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5619	040	2	1	01	01	H5619_040_2	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5628	001	0	1	01	01	H5628_001_0	8	Preferred Generic	3	001001	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	Generic	3	010001	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	Preferred Brand	3	000101	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	34.00	68.00	102.00																			34.00	68.00	102.00																34.00				34.00		1.10			1.10			1.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5628	001	0	1	01	01	H5628_001_0	8	Non-Preferred Drug	3	100100	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				87.26	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5628	001	0	1	01	01	H5628_001_0	8	Specialty Tier	3	010010	1	1	5	1	010		01	010		1	31								31						31		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5628	007	0	1	01	01	H5628_007_0	13	Preferred Generic	4	001001	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	9.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5628	007	0	1	01	01	H5628_007_0	13	Generic	4	010001	1	2	2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	10.00	20.00	30.00																			10.00	20.00	30.00																10.00				10.00		0.32			0.32			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5628	007	0	1	01	01	H5628_007_0	13	Preferred Brand	4	000101	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												
H5628	007	0	1	01	01	H5628_007_0	13	Non-Preferred Drug	4	100100	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				69.98	35	35	35																		35	35	35															35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5628	007	0	1	01	01	H5628_007_0	13	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	31								31						31		31					33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5649	001	0	1	01	01	H5649_001_0	9	Preferred Generic	4	001010	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	9	Preferred Generic	4	001010	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	9	Generic	4	010010	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	5.00		15.00																					10.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	001	0	1	01	01	H5649_001_0	9	Generic	4	010010	1	2	2	3	110		01	100		1	30		90				1	2			90				30		31	5.00		15.00																					10.00																5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5649	001	0	1	01	01	H5649_001_0	9	Preferred Brand	4	010001	3	2	3	1	110		01	100		1	30		90				1	2			90				30		31	35.00		105.00																					70.00																35.00				35.00		1.17						1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	001	0	1	01	01	H5649_001_0	9	Non-Preferred Drug	4	100100	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	75.00		225.00																					150.00																75.00				75.00		2.50						2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	001	0	1	01	01	H5649_001_0	9	Specialty Tier	4	010010	1	1	5	1	010		01			1	30														30		31				506.12	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	001	0	1	01	01	H5649_001_0	9	Select Care Drugs	4	000010	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	10.00		30.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	002	0	1	01	01	H5649_002_0	11	Preferred Generic	4	001010	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	002	0	1	01	01	H5649_002_0	11	Preferred Generic	4	001010	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	11	Generic	4	010010	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	002	0	1	01	01	H5649_002_0	11	Generic	4	010010	1	2	2	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5649	002	0	1	01	01	H5649_002_0	11	Preferred Brand	4	010001	3	1	3	1	110		01	100		1	30		90				1	2			90				30		31				97.80	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	002	0	1	01	01	H5649_002_0	11	Non-Preferred Drug	4	100100	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				76.51	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	002	0	1	01	01	H5649_002_0	11	Specialty Tier	4	010010	1	1	5	1	010		01			1	30														30		31				373.49	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	002	0	1	01	01	H5649_002_0	11	Select Care Drugs	4	000010	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	10.00		30.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	004	0	1	01	01	H5649_004_0	9	Preferred Generic	4	001010	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	004	0	1	01	01	H5649_004_0	9	Preferred Generic	4	001010	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	004	0	1	01	01	H5649_004_0	9	Generic	4	010010	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	004	0	1	01	01	H5649_004_0	9	Generic	4	010010	1	2	2	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5649	004	0	1	01	01	H5649_004_0	9	Preferred Brand	4	010001	3	1	3	1	110		01	100		1	30		90				1	2			90				30		31				62.27	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	004	0	1	01	01	H5649_004_0	9	Non-Preferred Drug	4	100100	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				87.94	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	004	0	1	01	01	H5649_004_0	9	Specialty Tier	4	010010	1	1	5	1	010		01			1	30														30		31				358.47	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	004	0	1	01	01	H5649_004_0	9	Select Care Drugs	4	000010	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	10.00		30.00																					30.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	006	0	1	01	01	H5649_006_0	9	Preferred Generic	4	001010	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	9	Preferred Generic	4	001010	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	9	Generic	4	010010	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	5.00		15.00																					10.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	006	0	1	01	01	H5649_006_0	9	Generic	4	010010	1	2	2	3	110		01	100		1	30		90				1	2			90				30		31	5.00		15.00																					10.00																5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5649	006	0	1	01	01	H5649_006_0	9	Preferred Brand	4	010001	3	2	3	1	110		01	100		1	30		90				1	2			90				30		31	35.00		105.00																					70.00																35.00				35.00		1.17						1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	006	0	1	01	01	H5649_006_0	9	Non-Preferred Drug	4	100100	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	75.00		225.00																					150.00																75.00				75.00		2.50						2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	006	0	1	01	01	H5649_006_0	9	Specialty Tier	4	010010	1	1	5	1	010		01			1	30														30		31				480.07	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	006	0	1	01	01	H5649_006_0	9	Select Care Drugs	4	000010	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	006	0	1	01	01	H5649_006_0	9	Select Care Drugs	4	000010	1	2	6	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5649	007	0	1	01	01	H5649_007_0	10	Preferred Generic	4	001010	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	007	0	1	01	01	H5649_007_0	10	Preferred Generic	4	001010	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	007	0	1	01	01	H5649_007_0	10	Generic	4	010010	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	007	0	1	01	01	H5649_007_0	10	Generic	4	010010	1	2	2	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5649	007	0	1	01	01	H5649_007_0	10	Preferred Brand	4	010001	1	1	3	1	110		01	100		1	30		90				1	2			90				30		31				62.27	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	007	0	1	01	01	H5649_007_0	10	Non-Preferred Drug	4	100100	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				87.94	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	007	0	1	01	01	H5649_007_0	10	Specialty Tier	4	010010	1	1	5	1	010		01			1	30														30		31				358.47	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	007	0	1	01	01	H5649_007_0	10	Select Care Drugs	4	000010	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	10.00		30.00																					30.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	008	0	1	01	01	H5649_008_0	8	Preferred Generic	4	001010	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	4.00		12.00																					8.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	008	0	1	01	01	H5649_008_0	8	Preferred Generic	4	001010	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	4.00		12.00																					8.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5649	008	0	1	01	01	H5649_008_0	8	Generic	4	010010	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	9.00		27.00																					18.00																9.00				9.00		0.30						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	008	0	1	01	01	H5649_008_0	8	Generic	4	010010	1	2	2	3	110		01	100		1	30		90				1	2			90				30		31	9.00		27.00																					18.00																9.00				9.00		0.30						0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5649	008	0	1	01	01	H5649_008_0	8	Preferred Brand	4	010001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	45.00		135.00																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	008	0	1	01	01	H5649_008_0	8	Non-Preferred Drug	4	100100	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	90.00		270.00																					180.00																90.00				90.00		3.00						2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	008	0	1	01	01	H5649_008_0	8	Specialty Tier	4	010010	1	1	5	1	010		01			1	30														30		31				688.07	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	008	0	1	01	01	H5649_008_0	8	Select Care Drugs	4	000010	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	10.00		10.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	009	0	1	01	01	H5649_009_0	10	Preferred Generic	4	001010	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	009	0	1	01	01	H5649_009_0	10	Preferred Generic	4	001010	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	10	Generic	4	010010	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	009	0	1	01	01	H5649_009_0	10	Generic	4	010010	1	2	2	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5649	009	0	1	01	01	H5649_009_0	10	Preferred Brand	4	010001	1	1	3	1	110		01	100		1	30		90				1	2			90				30		31				97.80	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	009	0	1	01	01	H5649_009_0	10	Non-Preferred Drug	4	100100	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				76.51	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	009	0	1	01	01	H5649_009_0	10	Specialty Tier	4	010010	1	1	5	1	010		01			1	30														30		31				373.49	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	009	0	1	01	01	H5649_009_0	10	Select Care Drugs	4	000010	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	10.00		30.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	010	0	1	01	01	H5649_010_0	8	Preferred Generic	4	001010	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	010	0	1	01	01	H5649_010_0	8	Preferred Generic	4	001010	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	010	0	1	01	01	H5649_010_0	8	Generic	4	010010	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	010	0	1	01	01	H5649_010_0	8	Generic	4	010010	1	2	2	3	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5649	010	0	1	01	01	H5649_010_0	8	Preferred Brand	4	010001	1	1	3	1	110		01	100		1	30		90				1	2			90				30		31				107.13	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	010	0	1	01	01	H5649_010_0	8	Non-Preferred Drug	4	100100	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				82.17	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	010	0	1	01	01	H5649_010_0	8	Specialty Tier	4	010010	1	1	5	1	010		01			1	30														30		31				414.20	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5649	010	0	1	01	01	H5649_010_0	8	Select Care Drugs	4	000010	1	2	6	1	110		01	100		1	30		90				1	2			90				30		31	10.00		30.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5652	001	0	1	02	01	H5652_001_0	5	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	5.00		15.00																											15.00						0.00				5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5652	001	0	1	02	01	H5652_001_0	5	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5652	001	0	1	02	01	H5652_001_0	5	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		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	5	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	85.00		255.00																											255.00						245.00				85.00				85.00		2.83						2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5652	001	0	1	02	01	H5652_001_0	5	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				539.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5652	003	0	1	02	01	H5652_003_0	6	Preferred Generic	4	001000	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5652	003	0	1	02	01	H5652_003_0	6	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	0.00		0.00																											0.00						0.00				0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5652	003	0	1	02	01	H5652_003_0	6	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	28.00		84.00																											84.00						74.00				28.00				28.00		.93						.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5652	003	0	1	02	01	H5652_003_0	6	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	70.00		210.00																											210.00						200.00				70.00				70.00		2.33						2.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5652	003	0	1	02	01	H5652_003_0	6	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				326.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5652	004	0	1	02	01	H5652_004_0	6	Preferred Generic	4	001000	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5652	004	0	1	02	01	H5652_004_0	6	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		30.00																											30.00						0.00				10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5652	004	0	1	02	01	H5652_004_0	6	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		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	6	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	85.00		255.00																											255.00						245.00				85.00				85.00		2.83						2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5652	004	0	1	02	01	H5652_004_0	6	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				718.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5652	006	0	1	02	01	H5652_006_0	6	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	5.00		15.00																											15.00						0.00				5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5652	006	0	1	02	01	H5652_006_0	6	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	10.00		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	6	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		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	6	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	85.00		255.00																											255.00						245.00				85.00				85.00		2.83						2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5652	006	0	1	02	01	H5652_006_0	6	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				539.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5656	001	0	1	01	01	H5656_001_0	16	Preferred Generic	4	001001	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		34								5.00		12.50					0.00		0.00											5.00		12.50				0.00		0.00				5.00				5.00			0.17	0.00		0.17	0.00	0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5656	001	0	1	01	01	H5656_001_0	16	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		34								10.00		25.00					5.00		12.50											10.00		25.00				5.00		5.00				10.00				10.00			0.33	0.17		0.33	0.17	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5656	001	0	1	01	01	H5656_001_0	16	Preferred Brand	4	000101	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		34								45.00		112.50					35.00		87.50											45.00		112.50				35.00		70.00				45.00				45.00			1.50	1.17		1.50	1.17	1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5656	001	0	1	01	01	H5656_001_0	16	Non-Preferred Drug	4	100100	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		34								85.00		212.50					75.00		187.50											85.00		212.50				75.00		150.00				85.00				85.00			2.83	2.50		2.83	2.50	2.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5656	001	0	1	01	01	H5656_001_0	16	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		34											1.00	33						1.00	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5685	001	0	1	01	01	H5685_001_0	6	Generic	4	010000	1	1	1	1	010		10			1	30															29	31				5.50	25																																						25		25								Generic, Brand												
H5685	001	0	1	01	01	H5685_001_0	6	Brand	4	000010	1	1	2	1	010		10			1	30															29	31				82.80	25																																						25		25								Generic, Brand												
H5746	016	0	1	01	01	H5746_016_0	7	Preferred Generic	4	001000	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												
H5746	016	0	1	01	01	H5746_016_0	7	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								19.00	38.00	57.00					14.00	28.00	42.00					14.00	42.00	42.00																19.00				19.00			0.63	0.47	0.47			0.56	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5746	016	0	1	01	01	H5746_016_0	7	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	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	016	0	1	01	01	H5746_016_0	7	Non-Preferred Drug	4	100100	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												
H5746	016	0	1	01	01	H5746_016_0	7	Specialty Tier	4	010010	1	1	5	1		010	01	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	016	0	1	01	01	H5746_016_0	7	Select Care Drugs	4	001000	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			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	7	Select Care Drugs	4	001000	1	2	6	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		
H5774	005	0	1	01	01	H5774_005_0	11	Preferred Generic	4	001000	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								10.00		20.00					5.00		10.00							10.00																10.00				5.00			0.33	0.17				.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5774	005	0	1	01	01	H5774_005_0	11	Preferred Generic	4	001000	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								10.00		20.00					5.00		10.00							10.00																10.00				5.00			0.33	0.17				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5774	005	0	1	01	01	H5774_005_0	11	Generic	4	010000	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		40.00					10.00		20.00							20.00																20.00				10.00			0.67	0.33				.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5774	005	0	1	01	01	H5774_005_0	11	Generic	4	010000	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								20.00		40.00					10.00		20.00							20.00																20.00				10.00			0.67	0.33				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5774	005	0	1	01	01	H5774_005_0	11	Preferred Brand	4	000101	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								45.00		90.00					35.00		70.00							70.00																45.00				35.00			1.50	1.17				1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5774	005	0	1	01	01	H5774_005_0	11	Non-Preferred Brand	4	100100	1	2	4	1		110	01	100		1				30		90	1	1			90				30		31								75.00		150.00					50.00		100.00							100.00																75.00				50.00			2.50	1.67				1.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5774	005	0	1	01	01	H5774_005_0	11	Specialty Tier	4	100100	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												
H5774	022	0	1	01	01	H5774_022_0	11	Preferred Generic	4	001000	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								10.00		20.00					5.00		10.00							10.00																10.00				5.00			0.33	0.17				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5774	022	0	1	01	01	H5774_022_0	11	Preferred Generic	4	001000	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								10.00		20.00					5.00		10.00							10.00																10.00				5.00			0.33	0.17				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5774	022	0	1	01	01	H5774_022_0	11	Generic	4	010000	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		40.00					10.00		20.00							20.00																20.00				10.00			0.67	0.33				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5774	022	0	1	01	01	H5774_022_0	11	Generic	4	010000	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								20.00		40.00					10.00		20.00							20.00																20.00				10.00			0.67	0.33				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5774	022	0	1	01	01	H5774_022_0	11	Preferred Brand	4	000101	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								45.00		90.00					35.00		70.00							70.00																45.00				35.00			1.50	1.17				1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5774	022	0	1	01	01	H5774_022_0	11	Non-Preferred Brand	4	100100	1	2	4	1		110	01	100		1				30		90	1	1			90				30		31								75.00		150.00					50.00		100.00							100.00																75.00				50.00			2.50	1.67				1.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5774	022	0	1	01	01	H5774_022_0	11	Specialty Tier	4	100100	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												
H5774	023	0	1	02	01	H5774_023_0	13	Preferred Generic	4	001000	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								10.00		20.00					5.00		10.00							10.00																10.00				5.00			0.33	0.17				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5774	023	0	1	02	01	H5774_023_0	13	Preferred Generic	4	001000	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								10.00		20.00					5.00		10.00							10.00																10.00				5.00			0.33	0.17				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5774	023	0	1	02	01	H5774_023_0	13	Generic	4	010000	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		40.00					10.00		20.00							20.00																20.00				10.00			0.67	0.33				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5774	023	0	1	02	01	H5774_023_0	13	Generic	4	010000	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								20.00		40.00					10.00		20.00							20.00																20.00				10.00			0.67	0.33				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5774	023	0	1	02	01	H5774_023_0	13	Preferred Brand	4	000101	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								45.00		90.00					35.00		70.00							70.00																45.00				35.00			1.50	1.17				1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5774	023	0	1	02	01	H5774_023_0	13	Non-Preferred Brand	4	100100	1	2	4	1		110	01	100		1				30		90	1	1			90				30		31								75.00		150.00					50.00		100.00							100.00																75.00				50.00			2.50	1.67				1.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5774	023	0	1	02	01	H5774_023_0	13	Specialty Tier	4	100100	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												
H5774	024	0	1	01	01	H5774_024_0	12	Preferred Generic	2	001000	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								10.00		20.00					4.00		8.00							8.00																10.00				4.00			0.33	0.13				0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5774	024	0	1	01	01	H5774_024_0	12	Generic	2	010000	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		40.00					10.00		20.00							20.00																20.00				10.00			0.67	0.33				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5774	024	0	1	01	01	H5774_024_0	12	Preferred Brand	2	000101	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								45.00		90.00					35.00		70.00							70.00																45.00				35.00			1.50	1.17				1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5774	024	0	1	01	01	H5774_024_0	12	Non-Preferred Brand	2	100100	1	2	4	1		110	01	100		1				30		90	1	1			90				30		31								95.00		190.00					50.00		100.00							100																95.00				50.00			3.17	1.67				1.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5774	024	0	1	01	01	H5774_024_0	12	Specialty Tier	2	100100	1	1	5	1		110	01	100		1				30		90	1	1			90				30		31											15.00	25		25				15.00	25		25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5774	025	0	1	01	01	H5774_025_0	12	Preferred Generic	2	001000	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								10.00		20.00					4.00		8.00							8.00																10.00				4.00			0.33	0.13				0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5774	025	0	1	01	01	H5774_025_0	12	Generic	2	010000	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		40.00					10.00		20.00							20.00																20.00				10.00			0.67	0.33				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5774	025	0	1	01	01	H5774_025_0	12	Preferred Brand	2	000101	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								45.00		90.00					35.00		70.00							70.00																45.00				35.00			1.50	1.17				1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5774	025	0	1	01	01	H5774_025_0	12	Non-Preferred Brand	2	100100	1	2	4	1		110	01	100		1				30		90	1	1			90				30		31								95.00		190.00					50.00		100.00							100																95.00				50.00			3.17	1.67				1.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5774	025	0	1	01	01	H5774_025_0	12	Specialty Tier	2	100100	1	1	5	1		110	01	100		1				30		90	1	1			90				30		31											15.00	25		25				15.00	25		25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5774	026	0	1	01	01	H5774_026_0	14	Preferred Generic	2	001000	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								10.00		20.00					4.00		8.00							8.00																10.00				4.00			0.33	0.13				0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5774	026	0	1	01	01	H5774_026_0	14	Generic	2	010000	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		40.00					10.00		20.00							20.00																20.00				10.00			0.67	0.33				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5774	026	0	1	01	01	H5774_026_0	14	Preferred Brand	2	000101	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								45.00		90.00					35.00		70.00							70.00																45.00				35.00			1.50	1.17				1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5774	026	0	1	01	01	H5774_026_0	14	Non-Preferred Brand	2	100100	1	2	4	1		110	01	100		1				30		90	1	1			90				30		31								95.00		190.00					50.00		100.00							100																95.00				50.00			3.17	1.67				1.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5774	026	0	1	01	01	H5774_026_0	14	Specialty Tier	2	100100	1	1	5	1		110	01	100		1				30		90	1	1			90				30		31											15.00	25		25				15.00	25		25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5779	002	0	1	01	01	H5779_002_0	7	Preferred Generic	4	001010	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5779	002	0	1	01	01	H5779_002_0	7	Generic	4	010010	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	20.00		60.00																					40.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5779	002	0	1	01	01	H5779_002_0	7	Preferred Brand	4	010001	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	47.00		141.00																					94.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5779	002	0	1	01	01	H5779_002_0	7	Non-Preferred Brand	4	110000	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	100.00		300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5779	002	0	1	01	01	H5779_002_0	7	Specialty Tier	4	010010	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31					33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5779	003	0	1	01	01	H5779_003_0	7	Preferred Generic	4	001010	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5779	003	0	1	01	01	H5779_003_0	7	Generic	4	010010	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	8.00		16.00																					16.00																8.00				8.00		0.27						0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5779	003	0	1	01	01	H5779_003_0	7	Preferred Brand	4	010001	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	35.00		70.00																					70.00																35.00				35.00		1.17						1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5779	003	0	1	01	01	H5779_003_0	7	Non-Preferred Brand	4	110000	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	85.00		225.00																					255.00																85.00				85.00		2.83						2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5779	003	0	1	01	01	H5779_003_0	7	Specialty Tier	4	010010	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31					33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5779	005	0	1	01	01	H5779_005_0	7	Preferred Generic	4	001010	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5779	005	0	1	01	01	H5779_005_0	7	Generic	4	010010	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	20.00		60.00																					40.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5779	005	0	1	01	01	H5779_005_0	7	Preferred Brand	4	010001	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	47.00		141.00																					94.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5779	005	0	1	01	01	H5779_005_0	7	Non-Preferred Brand	4	110000	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	100.00		300.00																					300.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5779	005	0	1	01	01	H5779_005_0	7	Specialty Tier	4	010010	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31					33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5793	001	0	1	01	01	H5793_001_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5793	001	0	1	01	01	H5793_001_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5793	001	0	1	01	01	H5793_001_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5793	001	0	1	01	01	H5793_001_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5793	001	0	1	01	01	H5793_001_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5793	001	0	1	01	01	H5793_001_0	3	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5793	001	0	1	01	01	H5793_001_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	27						1.00	27												27						27						27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5793	008	0	1	01	01	H5793_008_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5793	008	0	1	01	01	H5793_008_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5793	008	0	1	01	01	H5793_008_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5793	008	0	1	01	01	H5793_008_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5793	008	0	1	01	01	H5793_008_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	008	0	1	01	01	H5793_008_0	3	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	008	0	1	01	01	H5793_008_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5793	010	0	1	01	01	H5793_010_0	4	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5793	010	0	1	01	01	H5793_010_0	4	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5793	010	0	1	01	01	H5793_010_0	4	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5793	010	0	1	01	01	H5793_010_0	4	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5793	010	0	1	01	01	H5793_010_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5793	011	0	1	01	01	H5793_011_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5793	011	0	1	01	01	H5793_011_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5793	011	0	1	01	01	H5793_011_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5793	011	0	1	01	01	H5793_011_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5793	011	0	1	01	01	H5793_011_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5793	011	0	1	01	01	H5793_011_0	3	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5793	011	0	1	01	01	H5793_011_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5810	001	0	1	01	01	H5810_001_0	8	Preferred Generic	3	001001	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	8	Generic	3	010001	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												
H5810	001	0	1	01	01	H5810_001_0	8	Preferred Brand	3	000101	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												
H5810	001	0	1	01	01	H5810_001_0	8	Non-Preferred Drug	3	100100	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				86.73	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5810	001	0	1	01	01	H5810_001_0	8	Specialty Tier	3	010010	1	1	5	1	010		01	010		1	31								31						31		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5817	018	0	1	01	01	H5817_018_0	9	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					2.00	6.00	6.00																7.00				7.00			0.23	0.07	0.07			0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5817	018	0	1	01	01	H5817_018_0	9	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								13.00	26.00	39.00					8.00	16.00	24.00					8.00	24.00	24.00																13.00				13.00			0.43	0.27	0.27			0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5817	018	0	1	01	01	H5817_018_0	9	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	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												
H5817	018	0	1	01	01	H5817_018_0	9	Non-Preferred Drug	4	100100	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												
H5817	018	0	1	01	01	H5817_018_0	9	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5817	018	0	1	01	01	H5817_018_0	9	Select Care Drugs	4	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5817	018	0	1	01	01	H5817_018_0	9	Select Care Drugs	4	001000	1	2	6	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		
H5817	019	0	1	01	01	H5817_019_0	9	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					2.00	6.00	6.00																7.00				7.00			0.23	0.07	0.07			0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5817	019	0	1	01	01	H5817_019_0	9	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								13.00	26.00	39.00					8.00	16.00	24.00					8.00	24.00	24.00																13.00				13.00			0.43	0.27	0.27			0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5817	019	0	1	01	01	H5817_019_0	9	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	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												
H5817	019	0	1	01	01	H5817_019_0	9	Non-Preferred Drug	4	100100	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												
H5817	019	0	1	01	01	H5817_019_0	9	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5817	019	0	1	01	01	H5817_019_0	9	Select Care Drugs	4	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5817	019	0	1	01	01	H5817_019_0	9	Select Care Drugs	4	001000	1	2	6	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		
H5817	020	1	1	01	01	H5817_020_1	9	Preferred Generic	4	001000	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												
H5817	020	1	1	01	01	H5817_020_1	9	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								14.00	28.00	42.00					9.00	18.00	27.00					9.00	27.00	27.00																14.00				14.00			0.47	0.30	0.30			0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5817	020	1	1	01	01	H5817_020_1	9	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	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												
H5817	020	1	1	01	01	H5817_020_1	9	Non-Preferred Drug	4	100100	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												
H5817	020	1	1	01	01	H5817_020_1	9	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5817	020	1	1	01	01	H5817_020_1	9	Select Care Drugs	4	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5817	020	1	1	01	01	H5817_020_1	9	Select Care Drugs	4	001000	1	2	6	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		
H5817	020	2	1	01	01	H5817_020_2	9	Preferred Generic	4	001000	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												
H5817	020	2	1	01	01	H5817_020_2	9	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								14.00	28.00	42.00					9.00	18.00	27.00					9.00	27.00	27.00																14.00				14.00			0.47	0.30	0.30			0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5817	020	2	1	01	01	H5817_020_2	9	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	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												
H5817	020	2	1	01	01	H5817_020_2	9	Non-Preferred Drug	4	100100	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												
H5817	020	2	1	01	01	H5817_020_2	9	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5817	020	2	1	01	01	H5817_020_2	9	Select Care Drugs	4	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5817	020	2	1	01	01	H5817_020_2	9	Select Care Drugs	4	001000	1	2	6	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		
H5817	020	3	1	01	01	H5817_020_3	9	Preferred Generic	4	001000	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												
H5817	020	3	1	01	01	H5817_020_3	9	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								14.00	28.00	42.00					9.00	18.00	27.00					9.00	27.00	27.00																14.00				14.00			0.47	0.30	0.30			0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5817	020	3	1	01	01	H5817_020_3	9	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	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												
H5817	020	3	1	01	01	H5817_020_3	9	Non-Preferred Drug	4	100100	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												
H5817	020	3	1	01	01	H5817_020_3	9	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5817	020	3	1	01	01	H5817_020_3	9	Select Care Drugs	4	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5817	020	3	1	01	01	H5817_020_3	9	Select Care Drugs	4	001000	1	2	6	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		
H5817	020	4	1	01	01	H5817_020_4	9	Preferred Generic	4	001000	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												
H5817	020	4	1	01	01	H5817_020_4	9	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								14.00	28.00	42.00					9.00	18.00	27.00					9.00	27.00	27.00																14.00				14.00			0.47	0.30	0.30			0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5817	020	4	1	01	01	H5817_020_4	9	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	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												
H5817	020	4	1	01	01	H5817_020_4	9	Non-Preferred Drug	4	100100	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												
H5817	020	4	1	01	01	H5817_020_4	9	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5817	020	4	1	01	01	H5817_020_4	9	Select Care Drugs	4	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5817	020	4	1	01	01	H5817_020_4	9	Select Care Drugs	4	001000	1	2	6	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		
H5817	020	5	1	01	01	H5817_020_5	9	Preferred Generic	4	001000	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												
H5817	020	5	1	01	01	H5817_020_5	9	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								14.00	28.00	42.00					9.00	18.00	27.00					9.00	27.00	27.00																14.00				14.00			0.47	0.30	0.30			0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5817	020	5	1	01	01	H5817_020_5	9	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	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												
H5817	020	5	1	01	01	H5817_020_5	9	Non-Preferred Drug	4	100100	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												
H5817	020	5	1	01	01	H5817_020_5	9	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5817	020	5	1	01	01	H5817_020_5	9	Select Care Drugs	4	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5817	020	5	1	01	01	H5817_020_5	9	Select Care Drugs	4	001000	1	2	6	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		
H5817	020	6	1	01	01	H5817_020_6	9	Preferred Generic	4	001000	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												
H5817	020	6	1	01	01	H5817_020_6	9	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								14.00	28.00	42.00					9.00	18.00	27.00					9.00	27.00	27.00																14.00				14.00			0.47	0.30	0.30			0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5817	020	6	1	01	01	H5817_020_6	9	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	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												
H5817	020	6	1	01	01	H5817_020_6	9	Non-Preferred Drug	4	100100	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												
H5817	020	6	1	01	01	H5817_020_6	9	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5817	020	6	1	01	01	H5817_020_6	9	Select Care Drugs	4	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5817	020	6	1	01	01	H5817_020_6	9	Select Care Drugs	4	001000	1	2	6	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		
H5817	022	0	1	01	01	H5817_022_0	9	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					2.00	6.00	6.00																7.00				7.00			0.23	0.07	0.07			0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5817	022	0	1	01	01	H5817_022_0	9	Generic	4	010000	1	2	2	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												
H5817	022	0	1	01	01	H5817_022_0	9	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	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												
H5817	022	0	1	01	01	H5817_022_0	9	Non-Preferred Drug	4	100100	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												
H5817	022	0	1	01	01	H5817_022_0	9	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5817	022	0	1	01	01	H5817_022_0	9	Select Care Drugs	4	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5817	022	0	1	01	01	H5817_022_0	9	Select Care Drugs	4	001000	1	2	6	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		
H5817	023	0	1	01	01	H5817_023_0	9	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					2.00	6.00	6.00																7.00				7.00			0.23	0.07	0.07			0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5817	023	0	1	01	01	H5817_023_0	9	Generic	4	010000	1	2	2	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												
H5817	023	0	1	01	01	H5817_023_0	9	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	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												
H5817	023	0	1	01	01	H5817_023_0	9	Non-Preferred Drug	4	100100	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												
H5817	023	0	1	01	01	H5817_023_0	9	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5817	023	0	1	01	01	H5817_023_0	9	Select Care Drugs	4	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5817	023	0	1	01	01	H5817_023_0	9	Select Care Drugs	4	001000	1	2	6	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		
H5817	024	1	1	01	01	H5817_024_1	8	Preferred Generic	4	001000	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												
H5817	024	1	1	01	01	H5817_024_1	8	Preferred Generic	4	001000	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		
H5817	024	1	1	01	01	H5817_024_1	8	Generic	4	010000	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												
H5817	024	1	1	01	01	H5817_024_1	8	Preferred Brand	4	000101	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												
H5817	024	1	1	01	01	H5817_024_1	8	Non-Preferred Drug	4	100100	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												
H5817	024	1	1	01	01	H5817_024_1	8	Specialty Tier	4	010010	1	1	5	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												
H5817	024	1	1	01	01	H5817_024_1	8	Select Care Drugs	4	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5817	024	1	1	01	01	H5817_024_1	8	Select Care Drugs	4	001000	1	2	6	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		
H5817	024	2	1	01	01	H5817_024_2	8	Preferred Generic	4	001000	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												
H5817	024	2	1	01	01	H5817_024_2	8	Preferred Generic	4	001000	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		
H5817	024	2	1	01	01	H5817_024_2	8	Generic	4	010000	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												
H5817	024	2	1	01	01	H5817_024_2	8	Preferred Brand	4	000101	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												
H5817	024	2	1	01	01	H5817_024_2	8	Non-Preferred Drug	4	100100	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												
H5817	024	2	1	01	01	H5817_024_2	8	Specialty Tier	4	010010	1	1	5	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												
H5817	024	2	1	01	01	H5817_024_2	8	Select Care Drugs	4	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5817	024	2	1	01	01	H5817_024_2	8	Select Care Drugs	4	001000	1	2	6	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		
H5817	024	3	1	01	01	H5817_024_3	8	Preferred Generic	4	001000	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												
H5817	024	3	1	01	01	H5817_024_3	8	Preferred Generic	4	001000	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		
H5817	024	3	1	01	01	H5817_024_3	8	Generic	4	010000	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												
H5817	024	3	1	01	01	H5817_024_3	8	Preferred Brand	4	000101	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												
H5817	024	3	1	01	01	H5817_024_3	8	Non-Preferred Drug	4	100100	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												
H5817	024	3	1	01	01	H5817_024_3	8	Specialty Tier	4	010010	1	1	5	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												
H5817	024	3	1	01	01	H5817_024_3	8	Select Care Drugs	4	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5817	024	3	1	01	01	H5817_024_3	8	Select Care Drugs	4	001000	1	2	6	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		
H5817	025	0	1	02	01	H5817_025_0	8	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5817	025	0	1	02	01	H5817_025_0	8	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								16.00	32.00	48.00					11.00	22.00	33.00					11.00	33.00	33.00																16.00				16.00			0.53	0.37	0.37			0.47	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5817	025	0	1	02	01	H5817_025_0	8	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	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												
H5817	025	0	1	02	01	H5817_025_0	8	Non-Preferred Drug	4	100100	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												
H5817	025	0	1	02	01	H5817_025_0	8	Specialty Tier	4	010010	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												
H5817	025	0	1	02	01	H5817_025_0	8	Select Care Drugs	4	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5823	006	0	1	01	01	H5823_006_0	8	Preferred Generic	3	001001	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	Generic	3	010001	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	Preferred Brand	3	000101	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	37.00	74.00	111.00																			37.00	74.00	111.00																37.00				37.00		1.19			1.19			1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5823	006	0	1	01	01	H5823_006_0	8	Non-Preferred Drug	3	100100	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				90.56	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5823	006	0	1	01	01	H5823_006_0	8	Specialty Tier	3	010010	1	1	5	1	010		01	010		1	31								31						31		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5823	007	0	1	01	01	H5823_007_0	8	Preferred Generic	3	001001	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	007	0	1	01	01	H5823_007_0	8	Generic	3	010001	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	007	0	1	01	01	H5823_007_0	8	Preferred Brand	3	000101	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	37.00	74.00	111.00																			37.00	74.00	111.00																37.00				37.00		1.19			1.19			1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5823	007	0	1	01	01	H5823_007_0	8	Non-Preferred Drug	3	100100	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				90.58	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5823	007	0	1	01	01	H5823_007_0	8	Specialty Tier	3	010010	1	1	5	1	010		01	010		1	31								31						31		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5826	008	0	1	01	01	H5826_008_0	5	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	34		90				1	2			90				34		34	2.00		5.00																					5.00																2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5826	008	0	1	01	01	H5826_008_0	5	Generic	4	010000	1	2	2	1	110		01	100		1	34		90				1	2			90				34		34	20.00		50.00																					50.00																20.00				20.00		0.59						0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5826	008	0	1	01	01	H5826_008_0	5	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	34		90				1	2			90				34		34	47.00		135.00																					135.00																47.00				47.00		1.38						1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5826	008	0	1	01	01	H5826_008_0	5	Non-Preferred Drug	4	100100	1	1	4	1	010		01	010		1	34								34						34		34				100.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5826	008	0	1	01	01	H5826_008_0	5	Specialty Tier	4	100101	1	1	5	1	010		01	010		1	34								34						34		34				100.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5826	009	0	1	01	01	H5826_009_0	5	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	34		90				1	2			90				34		34	2.00		5.00																					5.00																2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5826	009	0	1	01	01	H5826_009_0	5	Generic	4	010000	1	2	2	1	110		01	100		1	34		90				1	2			90				34		34	20.00		50.00																					50.00																20.00				20.00		0.59						0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5826	009	0	1	01	01	H5826_009_0	5	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	34		90				1	2			90				34		34	47.00		135.00																					135.00																47.00				47.00		1.38						1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5826	009	0	1	01	01	H5826_009_0	5	Non-Preferred Drug	4	100100	1	1	4	1	010		01	010		1	34								34						34		34				100.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5826	009	0	1	01	01	H5826_009_0	5	Specialty Tier	4	100101	1	1	5	1	010		01	010		1	34								34						34		34				100.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5826	010	0	1	01	01	H5826_010_0	6	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	34		90				1	2			90				34		34	2.00		5.00																					5.00																2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5826	010	0	1	01	01	H5826_010_0	6	Generic	4	010000	1	2	2	1	110		01	100		1	34		90				1	2			90				34		34	20.00		50.00																					50.00																20.00				20.00		0.59						0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5826	010	0	1	01	01	H5826_010_0	6	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	34		90				1	2			90				34		34	47.00		135.00																					135.00																47.00				47.00		1.38						1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5826	010	0	1	01	01	H5826_010_0	6	Non-Preferred Drug	4	100100	1	1	4	1	010		01	010		1	34								34						34		34				100.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5826	010	0	1	01	01	H5826_010_0	6	Specialty Tier	4	100101	1	1	5	1	010		01	010		1	34								34						34		34				100.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5852	001	0	1	01	01	H5852_001_0	6	Generic	2	010000	1	1	1	1	110		10			1	30		90				1	2								29	34				8.84	25		25																																				25		25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5852	001	0	1	01	01	H5852_001_0	6	Preferred Brand	2	000101	1	1	2	1	110		10			1	30		90				1	2								29	34				70.78	25		25																																				25		25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5852	001	0	1	01	01	H5852_001_0	6	Non-Preferred Brand	2	100000	1	1	3	1	010		10			1	30															29	34				90.54	25																																						25		25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5852	001	0	1	01	01	H5852_001_0	6	Specialty Tier	2	100000	1	1	4	1	010		10			1	30															29	34				348.23	25																																						25		25								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5854	007	0	1	01	01	H5854_007_0	7	Preferred Generic	4	001000	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												
H5854	007	0	1	01	01	H5854_007_0	7	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								19.00	38.00	57.00					14.00	28.00	42.00					14.00	42.00	42.00																19.00				19.00			0.63	0.47	0.47			0.56	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	007	0	1	01	01	H5854_007_0	7	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	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	7	Non-Preferred Drug	4	100100	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												
H5854	007	0	1	01	01	H5854_007_0	7	Specialty Tier	4	010010	1	1	5	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	7	Select Care Drugs	4	001000	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			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	7	Select Care Drugs	4	001000	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H5854	008	0	1	01	01	H5854_008_0	6	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	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												
H5854	008	0	1	01	01	H5854_008_0	6	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								16.00	32.00	48.00					16.00	32.00	48.00					16.00	48.00	48.00																16.00				16.00			0.53	0.53	0.53			0.47	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	008	0	1	01	01	H5854_008_0	6	Preferred Brand	4	000101	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												
H5854	008	0	1	01	01	H5854_008_0	6	Non-Preferred Drug	4	100100	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												
H5854	008	0	1	01	01	H5854_008_0	6	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	008	0	1	01	01	H5854_008_0	6	Select Care Drugs	4	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	008	0	1	01	01	H5854_008_0	6	Select Care Drugs	4	001000	1	2	6	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	009	0	1	01	01	H5854_009_0	7	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								8.00	16.00	24.00					3.00	6.00	9.00					3.00	9.00	9.00																8.00				8.00			0.27	0.10	0.10			0.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	009	0	1	01	01	H5854_009_0	7	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	009	0	1	01	01	H5854_009_0	7	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	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	Non-Preferred Drug	4	100100	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												
H5854	009	0	1	01	01	H5854_009_0	7	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		34												26							26						26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	009	0	1	01	01	H5854_009_0	7	Select Care Drugs	4	001000	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			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	Select Care Drugs	4	001000	1	2	6	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	010	0	1	01	01	H5854_010_0	8	Preferred Generic	4	001000	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	8	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								19.00	38.00	57.00					14.00	28.00	42.00					14.00	42.00	42.00																19.00				19.00			0.63	0.47	0.47			0.56	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	010	0	1	01	01	H5854_010_0	8	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								46.00	92.00	138.00					41.00	82.00	123.00					41.00	123.00	123.00																46.00				46.00			1.53	1.37	1.37			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5854	010	0	1	01	01	H5854_010_0	8	Non-Preferred Drug	4	100100	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												
H5854	010	0	1	01	01	H5854_010_0	8	Specialty Tier	4	010010	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	8	Select Care Drugs	4	001000	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			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	8	Select Care Drugs	4	001000	1	2	6	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		
H5859	003	0	1	02	01	H5859_003_0	7	Preferred Generic	4	001000	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				4.00		0.13			0.13			0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H5859	003	0	1	02	01	H5859_003_0	7	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	20.00	40.00	60.00																			20.00	40.00	60.00																20.00				20.00		0.66			.66			.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H5859	003	0	1	02	01	H5859_003_0	7	Preferred Brand	4	000001	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		1.56			1.56			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H5859	003	0	1	02	01	H5859_003_0	7	Non-Preferred Brand	4	100000	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H5859	003	0	1	02	01	H5859_003_0	7	Injectable Drugs	4	010010	1	2	5	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	100.00	200.00	300.00																			100.00	200.00	300.00																100.00				100.00		3.33			3.33			3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H5859	003	0	1	02	01	H5859_003_0	7	Specialty Tier	4	010010	1	1	6	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31				472.79	25	25	25																		25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
H5883	002	1	1	02	01	H5883_002_1	7	Preferred Generic	4	001000	1	2	1	1		110	01	110		1				31		90	1	2	31		90				31		31								3.00		9.00					3.00		7.50					3.00		7.50																3.00				3.00			0.10	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	002	1	1	02	01	H5883_002_1	7	Generic	4	010000	1	2	2	1		110	01	110		1				31		90	1	2	31		90				31		31								10.00		30.00					10.00		25.00					10.00		25.00																10.00				10.00			0.32	0.32	0.32			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	002	1	1	02	01	H5883_002_1	7	Preferred Brand	4	000001	1	2	3	1		110	01	110		1				31		90	1	2	31		90				31		31								40.00		120.00					40.00		100.00					40.00		100.00																40.00				40.00			1.29	1.29	1.29			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	002	1	1	02	01	H5883_002_1	7	Non-Preferred Drug	4	100100	1	1	4	1		110	01	110		1				31		90	1	2	31		90				31		31											56.00	45		45				56.00	45		42				45		42															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	002	1	1	02	01	H5883_002_1	7	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				31					31						31		31											1.00	33						1.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	002	2	1	02	01	H5883_002_2	6	Preferred Generic	4	001000	1	2	1	1		110	01	110		1				31		90	1	2	31		90				31		31								3.00		9.00					3.00		7.50					3.00		7.50																3.00				3.00			0.10	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	002	2	1	02	01	H5883_002_2	6	Generic	4	010000	1	2	2	1		110	01	110		1				31		90	1	2	31		90				31		31								10.00		30.00					10.00		25.00					10.00		25.00																10.00				10.00			0.32	0.32	0.32			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	002	2	1	02	01	H5883_002_2	6	Preferred Brand	4	000001	1	2	3	1		110	01	110		1				31		90	1	2	31		90				31		31								40.00		120.00					40.00		100.00					40.00		100.00																40.00				40.00			1.29	1.29	1.29			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	002	2	1	02	01	H5883_002_2	6	Non-Preferred Drug	4	100100	1	1	4	1		110	01	110		1				31		90	1	2	31		90				31		31											56.00	45		45				56.00	45		42				45		42															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	002	2	1	02	01	H5883_002_2	6	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				31					31						31		31											1.00	33						1.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	002	3	1	02	01	H5883_002_3	7	Preferred Generic	4	001000	1	2	1	1		110	01	110		1				31		90	1	2	31		90				31		31								3.00		9.00					3.00		7.50					3.00		7.50																3.00				3.00			0.10	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	002	3	1	02	01	H5883_002_3	7	Generic	4	010000	1	2	2	1		110	01	110		1				31		90	1	2	31		90				31		31								10.00		30.00					10.00		25.00					10.00		25.00																10.00				10.00			0.32	0.32	0.32			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	002	3	1	02	01	H5883_002_3	7	Preferred Brand	4	000001	1	2	3	1		110	01	110		1				31		90	1	2	31		90				31		31								40.00		120.00					40.00		100.00					40.00		100.00																40.00				40.00			1.29	1.29	1.29			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	002	3	1	02	01	H5883_002_3	7	Non-Preferred Drug	4	100100	1	1	4	1		110	01	110		1				31		90	1	2	31		90				31		31											56.00	45		45				56.00	45		42				45		42															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	002	3	1	02	01	H5883_002_3	7	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				31					31						31		31											1.00	33						1.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	002	4	1	02	01	H5883_002_4	7	Preferred Generic	4	001000	1	2	1	1		110	01	110		1				31		90	1	2	31		90				31		31								3.00		9.00					3.00		7.50					3.00		7.50																3.00				3.00			0.10	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	002	4	1	02	01	H5883_002_4	7	Generic	4	010000	1	2	2	1		110	01	110		1				31		90	1	2	31		90				31		31								10.00		30.00					10.00		25.00					10.00		25.00																10.00				10.00			0.32	0.32	0.32			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	002	4	1	02	01	H5883_002_4	7	Preferred Brand	4	000001	1	2	3	1		110	01	110		1				31		90	1	2	31		90				31		31								40.00		120.00					40.00		100.00					40.00		100.00																40.00				40.00			1.29	1.29	1.29			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	002	4	1	02	01	H5883_002_4	7	Non-Preferred Drug	4	100100	1	1	4	1		110	01	110		1				31		90	1	2	31		90				31		31											56.00	45		45				56.00	45		42				45		42															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	002	4	1	02	01	H5883_002_4	7	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				31					31						31		31											1.00	33						1.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	002	7	1	02	01	H5883_002_7	6	Preferred Generic	4	001000	1	2	1	1		110	01	110		1				31		90	1	2	31		90				31		31								3.00		9.00					3.00		7.50					3.00		7.50																3.00				3.00			0.10	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	002	7	1	02	01	H5883_002_7	6	Generic	4	010000	1	2	2	1		110	01	110		1				31		90	1	2	31		90				31		31								10.00		30.00					10.00		25.00					10.00		25.00																10.00				10.00			0.32	0.32	0.32			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	002	7	1	02	01	H5883_002_7	6	Preferred Brand	4	000001	1	2	3	1		110	01	110		1				31		90	1	2	31		90				31		31								40.00		120.00					40.00		100.00					40.00		100.00																40.00				40.00			1.29	1.29	1.29			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	002	7	1	02	01	H5883_002_7	6	Non-Preferred Drug	4	100100	1	1	4	1		110	01	110		1				31		90	1	2	31		90				31		31											56.00	45		45				56.00	45		42				45		42															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	002	7	1	02	01	H5883_002_7	6	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				31					31						31		31											1.00	33						1.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	003	1	1	02	01	H5883_003_1	7	Preferred Generic	4	001000	1	2	1	1		110	01	110		1				31		90	1	2	31		90				31		31								3.00		9.00					3.00		7.50					3.00		7.50																3.00				3.00			0.10	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	003	1	1	02	01	H5883_003_1	7	Generic	4	010000	1	2	2	1		110	01	110		1				31		90	1	2	31		90				31		31								10.00		30.00					10.00		25.00					10.00		25.00																10.00				10.00			0.32	0.32	0.32			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	003	1	1	02	01	H5883_003_1	7	Preferred Brand	4	000001	1	2	3	1		110	01	110		1				31		90	1	2	31		90				31		31								35.00		105.00					35.00		87.50					35.00		87.50																35.00				35.00			1.13	1.13	1.13			1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	003	1	1	02	01	H5883_003_1	7	Non-Preferred Drug	4	100100	1	1	4	1		110	01	110		1				31		90	1	2	31		90				31		31											53.00	45		45				53.00	45		42				45		42															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	003	1	1	02	01	H5883_003_1	7	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				31					31						31		31											1.00	33						1.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	003	2	1	02	01	H5883_003_2	6	Preferred Generic	4	001000	1	2	1	1		110	01	110		1				31		90	1	2	31		90				31		31								3.00		9.00					3.00		7.50					3.00		7.50																3.00				3.00			0.10	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	003	2	1	02	01	H5883_003_2	6	Generic	4	010000	1	2	2	1		110	01	110		1				31		90	1	2	31		90				31		31								10.00		30.00					10.00		25.00					10.00		25.00																10.00				10.00			0.32	0.32	0.32			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	003	2	1	02	01	H5883_003_2	6	Preferred Brand	4	000001	1	2	3	1		110	01	110		1				31		90	1	2	31		90				31		31								35.00		105.00					35.00		87.50					35.00		87.50																35.00				35.00			1.13	1.13	1.13			1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	003	2	1	02	01	H5883_003_2	6	Non-Preferred Drug	4	100100	1	1	4	1		110	01	110		1				31		90	1	2	31		90				31		31											53.00	45		45				53.00	45		42				45		42															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	003	2	1	02	01	H5883_003_2	6	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				31					31						31		31											1.00	33						1.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	003	3	1	02	01	H5883_003_3	7	Preferred Generic	4	001000	1	2	1	1		110	01	110		1				31		90	1	2	31		90				31		31								3.00		9.00					3.00		7.50					3.00		7.50																3.00				3.00			0.10	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	003	3	1	02	01	H5883_003_3	7	Generic	4	010000	1	2	2	1		110	01	110		1				31		90	1	2	31		90				31		31								10.00		30.00					10.00		25.00					10.00		25.00																10.00				10.00			0.32	0.32	0.32			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	003	3	1	02	01	H5883_003_3	7	Preferred Brand	4	000001	1	2	3	1		110	01	110		1				31		90	1	2	31		90				31		31								35.00		105.00					35.00		87.50					35.00		87.50																35.00				35.00			1.13	1.13	1.13			1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	003	3	1	02	01	H5883_003_3	7	Non-Preferred Drug	4	100100	1	1	4	1		110	01	110		1				31		90	1	2	31		90				31		31											53.00	45		45				53.00	45		42				45		42															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	003	3	1	02	01	H5883_003_3	7	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				31					31						31		31											1.00	33						1.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	003	4	1	02	01	H5883_003_4	7	Preferred Generic	4	001000	1	2	1	1		110	01	110		1				31		90	1	2	31		90				31		31								3.00		9.00					3.00		7.50					3.00		7.50																3.00				3.00			0.10	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	003	4	1	02	01	H5883_003_4	7	Generic	4	010000	1	2	2	1		110	01	110		1				31		90	1	2	31		90				31		31								10.00		30.00					10.00		25.00					10.00		25.00																10.00				10.00			0.32	0.32	0.32			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	003	4	1	02	01	H5883_003_4	7	Preferred Brand	4	000001	1	2	3	1		110	01	110		1				31		90	1	2	31		90				31		31								35.00		105.00					35.00		87.50					35.00		87.50																35.00				35.00			1.13	1.13	1.13			1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	003	4	1	02	01	H5883_003_4	7	Non-Preferred Drug	4	100100	1	1	4	1		110	01	110		1				31		90	1	2	31		90				31		31											53.00	45		45				53.00	45		42				45		42															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	003	4	1	02	01	H5883_003_4	7	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				31					31						31		31											1.00	33						1.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	003	5	1	02	01	H5883_003_5	6	Preferred Generic	4	001000	1	2	1	1		110	01	110		1				31		90	1	2	31		90				31		31								3.00		9.00					3.00		7.50					3.00		7.50																3.00				3.00			0.10	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	003	5	1	02	01	H5883_003_5	6	Generic	4	010000	1	2	2	1		110	01	110		1				31		90	1	2	31		90				31		31								10.00		30.00					10.00		25.00					10.00		25.00																10.00				10.00			0.32	0.32	0.32			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	003	5	1	02	01	H5883_003_5	6	Preferred Brand	4	000001	1	2	3	1		110	01	110		1				31		90	1	2	31		90				31		31								35.00		105.00					35.00		87.50					35.00		87.50																35.00				35.00			1.13	1.13	1.13			1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	003	5	1	02	01	H5883_003_5	6	Non-Preferred Drug	4	100100	1	1	4	1		110	01	110		1				31		90	1	2	31		90				31		31											53.00	45		45				53.00	45		42				45		42															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	003	5	1	02	01	H5883_003_5	6	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				31					31						31		31											1.00	33						1.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	004	1	1	02	01	H5883_004_1	7	Preferred Generic	3	001000	1	2	1	1		110	01	110		1				31		90	1	2	31		90				31		31								5.00		15.00					5.00		12.50					5.00		12.50																5.00				5.00			0.16	0.16	0.16			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	004	1	1	02	01	H5883_004_1	7	Generic	3	010000	1	2	2	1		110	01	110		1				31		90	1	2	31		90				31		31								18.00		54.00					18.00		45.00					18.00		45.00																18.00				18.00			0.58	0.58	0.58			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	004	1	1	02	01	H5883_004_1	7	Preferred Brand	3	000001	1	2	3	1		110	01	110		1				31		90	1	2	31		90				31		31								47.00		141.00					47.00		117.50					47.00		117.50																47.00				47.00			1.52	1.52	1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	004	1	1	02	01	H5883_004_1	7	Non-Preferred Drug	3	100100	1	1	4	1		110	01	110		1				31		90	1	2	31		90				31		31											75.00	45		45				75.00	45		42				45		42															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	004	1	1	02	01	H5883_004_1	7	Specialty Tier	3	010010	1	1	5	1		010	01	010		1				31					31						31		31											1.00	25						1.00	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	004	2	1	02	01	H5883_004_2	6	Preferred Generic	3	001000	1	2	1	1		110	01	110		1				31		90	1	2	31		90				31		31								5.00		15.00					5.00		12.50					5.00		12.50																5.00				5.00			0.16	0.16	0.16			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	004	2	1	02	01	H5883_004_2	6	Generic	3	010000	1	2	2	1		110	01	110		1				31		90	1	2	31		90				31		31								18.00		54.00					18.00		45.00					18.00		45.00																18.00				18.00			0.58	0.58	0.58			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	004	2	1	02	01	H5883_004_2	6	Preferred Brand	3	000001	1	2	3	1		110	01	110		1				31		90	1	2	31		90				31		31								47.00		141.00					47.00		117.50					47.00		117.50																47.00				47.00			1.52	1.52	1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	004	2	1	02	01	H5883_004_2	6	Non-Preferred Drug	3	100100	1	1	4	1		110	01	110		1				31		90	1	2	31		90				31		31											75.00	45		45				75.00	45		42				45		42															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	004	2	1	02	01	H5883_004_2	6	Specialty Tier	3	010010	1	1	5	1		010	01	010		1				31					31						31		31											1.00	25						1.00	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	004	3	1	02	01	H5883_004_3	7	Preferred Generic	3	001000	1	2	1	1		110	01	110		1				31		90	1	2	31		90				31		31								5.00		15.00					5.00		12.50					5.00		12.50																5.00				5.00			0.16	0.16	0.16			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	004	3	1	02	01	H5883_004_3	7	Generic	3	010000	1	2	2	1		110	01	110		1				31		90	1	2	31		90				31		31								18.00		54.00					18.00		45.00					18.00		45.00																18.00				18.00			0.58	0.58	0.58			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	004	3	1	02	01	H5883_004_3	7	Preferred Brand	3	000001	1	2	3	1		110	01	110		1				31		90	1	2	31		90				31		31								47.00		141.00					47.00		117.50					47.00		117.50																47.00				47.00			1.52	1.52	1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	004	3	1	02	01	H5883_004_3	7	Non-Preferred Drug	3	100100	1	1	4	1		110	01	110		1				31		90	1	2	31		90				31		31											75.00	45		45				75.00	45		42				45		42															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	004	3	1	02	01	H5883_004_3	7	Specialty Tier	3	010010	1	1	5	1		010	01	010		1				31					31						31		31											1.00	25						1.00	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	004	4	1	02	01	H5883_004_4	7	Preferred Generic	3	001000	1	2	1	1		110	01	110		1				31		90	1	2	31		90				31		31								5.00		15.00					5.00		12.50					5.00		12.50																5.00				5.00			0.16	0.16	0.16			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	004	4	1	02	01	H5883_004_4	7	Generic	3	010000	1	2	2	1		110	01	110		1				31		90	1	2	31		90				31		31								18.00		54.00					18.00		45.00					18.00		45.00																18.00				18.00			0.58	0.58	0.58			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	004	4	1	02	01	H5883_004_4	7	Preferred Brand	3	000001	1	2	3	1		110	01	110		1				31		90	1	2	31		90				31		31								47.00		141.00					47.00		117.50					47.00		117.50																47.00				47.00			1.52	1.52	1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	004	4	1	02	01	H5883_004_4	7	Non-Preferred Drug	3	100100	1	1	4	1		110	01	110		1				31		90	1	2	31		90				31		31											75.00	45		45				75.00	45		42				45		42															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	004	4	1	02	01	H5883_004_4	7	Specialty Tier	3	010010	1	1	5	1		010	01	010		1				31					31						31		31											1.00	25						1.00	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	004	5	1	02	01	H5883_004_5	6	Preferred Generic	3	001000	1	2	1	1		110	01	110		1				31		90	1	2	31		90				31		31								5.00		15.00					5.00		12.50					5.00		12.50																5.00				5.00			0.16	0.16	0.16			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	004	5	1	02	01	H5883_004_5	6	Generic	3	010000	1	2	2	1		110	01	110		1				31		90	1	2	31		90				31		31								18.00		54.00					18.00		45.00					18.00		45.00																18.00				18.00			0.58	0.58	0.58			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	004	5	1	02	01	H5883_004_5	6	Preferred Brand	3	000001	1	2	3	1		110	01	110		1				31		90	1	2	31		90				31		31								47.00		141.00					47.00		117.50					47.00		117.50																47.00				47.00			1.52	1.52	1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	004	5	1	02	01	H5883_004_5	6	Non-Preferred Drug	3	100100	1	1	4	1		110	01	110		1				31		90	1	2	31		90				31		31											75.00	45		45				75.00	45		42				45		42															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	004	5	1	02	01	H5883_004_5	6	Specialty Tier	3	010010	1	1	5	1		010	01	010		1				31					31						31		31											1.00	25						1.00	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	007	0	1	01	01	H5883_007_0	5	Preferred Generic	4	001000	1	2	1	1		110	01	110		1				31		90	1	2	31		90				31		31								3.00		9.00					3.00		7.50					3.00		7.50																3.00				3.00			0.10	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	007	0	1	01	01	H5883_007_0	5	Generic	4	010000	1	2	2	1		110	01	110		1				31		90	1	2	31		90				31		31								15.00		45.00					15.00		37.50					15.00		37.50																15.00				15.00			0.48	0.48	0.48			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	007	0	1	01	01	H5883_007_0	5	Preferred Brand	4	000001	1	2	3	1		110	01	110		1				31		90	1	2	31		90				31		31								47.00		141.00					47.00		117.50					47.00		117.50																47.00				47.00			1.52	1.52	1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	007	0	1	01	01	H5883_007_0	5	Non-Preferred Drug	4	100100	1	1	4	1		110	01	110		1				31		90	1	2	31		90				31		31											82.00	45		45				82.00	45		42				45		42															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	007	0	1	01	01	H5883_007_0	5	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				31					31						31		31											1.00	33						1.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	008	1	1	01	01	H5883_008_1	5	Preferred Generic	4	001000	1	2	1	1		110	01	110		1				31		90	1	2	31		90				31		31								3.00		9.00					3.00		7.50					3.00		7.50																3.00				3.00			0.10	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	008	1	1	01	01	H5883_008_1	5	Generic	4	010000	1	2	2	1		110	01	110		1				31		90	1	2	31		90				31		31								15.00		45.00					15.00		37.50					15.00		37.50																15.00				15.00			0.48	0.48	0.48			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	008	1	1	01	01	H5883_008_1	5	Preferred Brand	4	000001	1	2	3	1		110	01	110		1				31		90	1	2	31		90				31		31								47.00		141.00					47.00		117.50					47.00		117.50																47.00				47.00			1.52	1.52	1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	008	1	1	01	01	H5883_008_1	5	Non-Preferred Drug	4	100100	1	1	4	1		110	01	110		1				31		90	1	2	31		90				31		31											56.00	45		45				56.00	45		42				45		42															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	008	1	1	01	01	H5883_008_1	5	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				31					31						31		31											1.00	33						1.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	008	2	1	01	01	H5883_008_2	5	Preferred Generic	4	001000	1	2	1	1		110	01	110		1				31		90	1	2	31		90				31		31								3.00		9.00					3.00		7.50					3.00		7.50																3.00				3.00			0.10	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	008	2	1	01	01	H5883_008_2	5	Generic	4	010000	1	2	2	1		110	01	110		1				31		90	1	2	31		90				31		31								15.00		45.00					15.00		37.50					15.00		37.50																15.00				15.00			0.48	0.48	0.48			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	008	2	1	01	01	H5883_008_2	5	Preferred Brand	4	000001	1	2	3	1		110	01	110		1				31		90	1	2	31		90				31		31								47.00		141.00					47.00		117.50					47.00		117.50																47.00				47.00			1.52	1.52	1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	008	2	1	01	01	H5883_008_2	5	Non-Preferred Drug	4	100100	1	1	4	1		110	01	110		1				31		90	1	2	31		90				31		31											56.00	45		45				56.00	45		42				45		42															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	008	2	1	01	01	H5883_008_2	5	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				31					31						31		31											1.00	33						1.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	009	1	1	01	01	H5883_009_1	5	Preferred Generic	4	001000	1	2	1	1		110	01	110		1				31		90	1	2	31		90				31		31								5.00		15.00					5.00		12.50					5.00		12.50																5.00				5.00			0.16	0.16	0.16			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	009	1	1	01	01	H5883_009_1	5	Generic	4	010000	1	2	2	1		110	01	110		1				31		90	1	2	31		90				31		31								20.00		60.00					20.00		50.00					20.00		50.00																20.00				20.00			0.65	0.65	0.65			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	009	1	1	01	01	H5883_009_1	5	Preferred Brand	4	000001	1	2	3	1		110	01	110		1				31		90	1	2	31		90				31		31								47.00		141.00					47.00		117.50					47.00		117.50																47.00				47.00			1.52	1.52	1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	009	1	1	01	01	H5883_009_1	5	Non-Preferred Drug	4	100100	1	1	4	1		110	01	110		1				31		90	1	2	31		90				31		31											78.00	45		45				78.00	45		42				45		42															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	009	1	1	01	01	H5883_009_1	5	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				31					31						31		31											1.00	31						1.00	31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	009	2	1	01	01	H5883_009_2	5	Preferred Generic	4	001000	1	2	1	1		110	01	110		1				31		90	1	2	31		90				31		31								5.00		15.00					5.00		12.50					5.00		12.50																5.00				5.00			0.16	0.16	0.16			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	009	2	1	01	01	H5883_009_2	5	Generic	4	010000	1	2	2	1		110	01	110		1				31		90	1	2	31		90				31		31								20.00		60.00					20.00		50.00					20.00		50.00																20.00				20.00			0.65	0.65	0.65			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	009	2	1	01	01	H5883_009_2	5	Preferred Brand	4	000001	1	2	3	1		110	01	110		1				31		90	1	2	31		90				31		31								47.00		141.00					47.00		117.50					47.00		117.50																47.00				47.00			1.52	1.52	1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	009	2	1	01	01	H5883_009_2	5	Non-Preferred Drug	4	100100	1	1	4	1		110	01	110		1				31		90	1	2	31		90				31		31											78.00	45		45				78.00	45		42				45		42															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	009	2	1	01	01	H5883_009_2	5	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				31					31						31		31											1.00	31						1.00	31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	009	3	1	01	01	H5883_009_3	5	Preferred Generic	4	001000	1	2	1	1		110	01	110		1				31		90	1	2	31		90				31		31								5.00		15.00					5.00		12.50					5.00		12.50																5.00				5.00			0.16	0.16	0.16			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	009	3	1	01	01	H5883_009_3	5	Generic	4	010000	1	2	2	1		110	01	110		1				31		90	1	2	31		90				31		31								20.00		60.00					20.00		50.00					20.00		50.00																20.00				20.00			0.65	0.65	0.65			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	009	3	1	01	01	H5883_009_3	5	Preferred Brand	4	000001	1	2	3	1		110	01	110		1				31		90	1	2	31		90				31		31								47.00		141.00					47.00		117.50					47.00		117.50																47.00				47.00			1.52	1.52	1.52			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	009	3	1	01	01	H5883_009_3	5	Non-Preferred Drug	4	100100	1	1	4	1		110	01	110		1				31		90	1	2	31		90				31		31											78.00	45		45				78.00	45		42				45		42															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5883	009	3	1	01	01	H5883_009_3	5	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				31					31						31		31											1.00	31						1.00	31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5926	001	0	1	01	01	H5926_001_0	8	Preferred Generic	3	001001	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	8	Generic	3	010001	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	8	Preferred Brand	3	000101	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												
H5926	001	0	1	01	01	H5926_001_0	8	Non-Preferred Drug	3	100100	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				98.20	46	46	46																		46	46	46															46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5926	001	0	1	01	01	H5926_001_0	8	Specialty Tier	3	010010	1	1	5	1	010		01	010		1	31								31						31		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	004	0	1	01	01	H5928_004_0	11	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	004	0	1	01	01	H5928_004_0	11	Preferred Generic	4	001000	1	2	1	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5928	004	0	1	01	01	H5928_004_0	11	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	5.00		12.50																					12.50																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	004	0	1	01	01	H5928_004_0	11	Generic	4	010000	1	2	2	3	110		01	100		1	30		90				2	2			90				30		31	5.00		12.50																					12.50																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5928	004	0	1	01	01	H5928_004_0	11	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	40.00		100.00																					100.00																40.00				40.00		1.33						1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	004	0	1	01	01	H5928_004_0	11	Non-Preferred Drug	4	100100	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	80.00		200.00																					200.00																80.00				80.00		2.67						2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	004	0	1	01	01	H5928_004_0	11	Specialty Tier	4	010010	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31				1199.85	33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	010	0	1	01	01	H5928_010_0	8	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	010	0	1	01	01	H5928_010_0	8	Preferred Generic	4	001000	1	2	1	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5928	010	0	1	01	01	H5928_010_0	8	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	7.00		17.50																					17.50																7.00				7.00		0.23						0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	010	0	1	01	01	H5928_010_0	8	Generic	4	010000	1	2	2	3	110		01	100		1	30		90				2	2			90				30		31	7.00		17.50																					17.50																7.00				7.00		0.23						0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5928	010	0	1	01	01	H5928_010_0	8	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	45.00		112.50																					112.50																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	010	0	1	01	01	H5928_010_0	8	Non-Preferred Drug	4	100100	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	90.00		225.00																					225.00																90.00				90.00		3.00						2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	010	0	1	01	01	H5928_010_0	8	Specialty Tier	4	010010	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31				1777.95	33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	016	0	1	01	01	H5928_016_0	8	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	016	0	1	01	01	H5928_016_0	8	Preferred Generic	4	001000	1	2	1	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5928	016	0	1	01	01	H5928_016_0	8	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	5.00		12.50																					12.50																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	016	0	1	01	01	H5928_016_0	8	Generic	4	010000	1	2	2	3	110		01	100		1	30		90				2	2			90				30		31	5.00		12.50																					12.50																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5928	016	0	1	01	01	H5928_016_0	8	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	40.00		100.00																					100.00																40.00				40.00		1.33						1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	016	0	1	01	01	H5928_016_0	8	Non-Preferred Drug	4	100100	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	80.00		200.00																					200.00																80.00				80.00		2.67						2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	016	0	1	01	01	H5928_016_0	8	Specialty Tier	4	010010	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31				1374.47	33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	037	0	1	01	01	H5928_037_0	11	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	037	0	1	01	01	H5928_037_0	11	Preferred Generic	4	001000	1	2	1	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5928	037	0	1	01	01	H5928_037_0	11	Generic	4	010000	1	1	2	1	110		01	100		1	30		90				2	2			90				30		31				5.29	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	037	0	1	01	01	H5928_037_0	11	Preferred Brand	4	000001	1	1	3	1	110		01	100		1	30		90				2	2			90				30		31				52.05	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	037	0	1	01	01	H5928_037_0	11	Non-Preferred Drug	4	100100	1	1	4	1	110		01	100		1	30		90				2	2			90				30		31				58.25	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	037	0	1	01	01	H5928_037_0	11	Specialty Tier	4	010010	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31				453.09	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	038	0	1	01	01	H5928_038_0	9	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	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	038	0	1	01	01	H5928_038_0	9	Preferred Generic	4	001000	1	2	1	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5928	038	0	1	01	01	H5928_038_0	9	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				2	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												
H5928	038	0	1	01	01	H5928_038_0	9	Generic	4	010000	1	2	2	3	110		01	100		1	30		90				2	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										1		
H5928	038	0	1	01	01	H5928_038_0	9	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	30.00		75.00																					75.00																30.00				30.00		1.00						0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	038	0	1	01	01	H5928_038_0	9	Non-Preferred Drug	4	100100	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	75.00		187.50																					187.50																75.00				75.00		2.50						2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	038	0	1	01	01	H5928_038_0	9	Specialty Tier	4	010010	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31				2662.26	33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	044	0	1	01	01	H5928_044_0	8	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	044	0	1	01	01	H5928_044_0	8	Preferred Generic	4	001000	1	2	1	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5928	044	0	1	01	01	H5928_044_0	8	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	5.00		12.50																					12.50																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	044	0	1	01	01	H5928_044_0	8	Generic	4	010000	1	2	2	3	110		01	100		1	30		90				2	2			90				30		31	5.00		12.50																					12.50																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5928	044	0	1	01	01	H5928_044_0	8	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				2	2			90				30		31	40.00		100.00																					100.00																40.00				40.00		1.33						1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	044	0	1	01	01	H5928_044_0	8	Non-Preferred Drug	4	100100	1	2	4	1	110		01	100		1	30		90				2	2			90				30		31	80.00		200.00																					200.00																80.00				80.00		2.67						2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	044	0	1	01	01	H5928_044_0	8	Specialty Tier	4	010010	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31				1697.19	33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	047	0	1	01	01	H5928_047_0	8	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	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	047	0	1	01	01	H5928_047_0	8	Preferred Generic	4	001000	1	2	1	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5928	047	0	1	01	01	H5928_047_0	8	Generic	4	010000	1	1	2	1	110		01	100		1	30		90				2	2			90				30		31				5.29	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	047	0	1	01	01	H5928_047_0	8	Preferred Brand	4	000001	1	1	3	1	110		01	100		1	30		90				2	2			90				30		31				52.05	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	047	0	1	01	01	H5928_047_0	8	Non-Preferred Drug	4	100100	1	1	4	1	110		01	100		1	30		90				2	2			90				30		31				58.25	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5928	047	0	1	01	01	H5928_047_0	8	Specialty Tier	4	010010	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31				453.09	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5932	010	0	1	01	01	H5932_010_0	10	Preferred Generic	4	001000	1	2	1	1	111		01	100		1	30	60	90				1	1			90				30		31	0.00	0.00	0.00																					9.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5932	010	0	1	01	01	H5932_010_0	10	Generic	4	010000	1	2	2	1	111		01	100		1	30	60	90				1	1			90				30		31	15.00	30.00	45.00																					48.00																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5932	010	0	1	01	01	H5932_010_0	10	Preferred Brand	4	000001	1	2	3	1	111		01	100		1	30	60	90				1	1			90				30		31	47.00	94.00	141.00																					135.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5932	010	0	1	01	01	H5932_010_0	10	Non-Preferred Brand	4	100000	1	2	4	1	111		01	100		1	30	60	90				1	1			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												
H5932	010	0	1	01	01	H5932_010_0	10	Specialty Tier	4	010010	1	1	5	1	111		01			1	30	60	90				1	1							30		31					25	25	25																																			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5938	001	0	1	01	01	H5938_001_0	6	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	7.50																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5938	001	0	1	01	01	H5938_001_0	6	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	7.00	14.00	21.00																			7.00	14.00	17.50																7.00				7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5938	001	0	1	01	01	H5938_001_0	6	Preferred Brand	4	010001	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5938	001	0	1	01	01	H5938_001_0	6	Non-Preferred Brand	4	110000	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	237.50																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5938	001	0	1	01	01	H5938_001_0	6	Specialty Tier	4	010010	1	4	5	1	010		01			1	30														30		31	250.00				25																																			250.00		25		250.00	25	8.33						8.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5938	006	0	1	01	01	H5938_006_0	5	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	7.50																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5938	006	0	1	01	01	H5938_006_0	5	Preferred Generic	4	001000	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	7.50																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5938	006	0	1	01	01	H5938_006_0	5	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	7.00	14.00	21.00																			7.00	14.00	17.50																7.00				7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5938	006	0	1	01	01	H5938_006_0	5	Generic	4	010000	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	7.00	14.00	21.00																			7.00	14.00	17.50																7.00				7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5938	006	0	1	01	01	H5938_006_0	5	Preferred Brand	4	010001	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5938	006	0	1	01	01	H5938_006_0	5	Non-Preferred Brand	4	110000	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	237.50																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5938	006	0	1	01	01	H5938_006_0	5	Specialty Tier	4	010010	1	4	5	1	010		01			1	30														30		31	250.00				25																																			250.00		25		250.00	25	8.33						8.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5943	001	0	1	02	01	H5943_001_0	9	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								3.00	6.00	9.00					0.00	0.00	0.00					0.00	0.00	0.00																3.00				3.00			0.10	0.00	0.00			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5943	001	0	1	02	01	H5943_001_0	9	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								13.00	26.00	39.00					8.00	16.00	24.00					8.00	16.00	24.00																13.00				13.00			0.43	0.27	0.27			0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5943	001	0	1	02	01	H5943_001_0	9	Preferred Brand	4	010001	1	1	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											169.42	25	25	25				169.42	25	25	25				25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5943	001	0	1	02	01	H5943_001_0	9	Non-Preferred Drug	4	100100	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											102.02	25	25	25				102.02	25	25	25				25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5943	001	0	1	02	01	H5943_001_0	9	Specialty Tier	4	010010	1	1	5	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												
H5943	001	0	1	02	01	H5943_001_0	9	Select Care Drugs	4	000010	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				11.00			0.37	0.37	0.37			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5943	002	0	1	02	01	H5943_002_0	9	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								3.50	7.00	10.50					0.00	0.00	0.00					0.00	0.00	0.00																3.50				3.50			0.12	0.00	0.00			0.11	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5943	002	0	1	02	01	H5943_002_0	9	Generic	4	010000	1	1	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											7.50	25	25	25				7.50	25	25	25				25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5943	002	0	1	02	01	H5943_002_0	9	Preferred Brand	4	010001	1	1	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											173.34	25	25	25				173.34	25	25	25				25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5943	002	0	1	02	01	H5943_002_0	9	Non-Preferred Drug	4	100100	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											103.94	25	25	25				103.94	25	25	25				25	25	25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5943	002	0	1	02	01	H5943_002_0	9	Specialty Tier	4	010010	1	1	5	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												
H5943	002	0	1	02	01	H5943_002_0	9	Select Care Drugs	4	000010	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				11.00			0.37	0.37	0.37			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H5945	001	0	1	01	01	H5945_001_0	12	Preferred Generic	4	001000	1	2	1	1	111		01	100		1	30	60	90				1	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												
H5945	001	0	1	01	01	H5945_001_0	12	Preferred Generic	4	001000	1	2	1	3	111		01	100		1	30	60	90				1	2			90				30		31	3.00	6.00	9.00																					6.00																3.00				3.00		0.10						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5945	001	0	1	01	01	H5945_001_0	12	Generic	4	010000	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	12.00	24.00	36.00																					24.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5945	001	0	1	01	01	H5945_001_0	12	Generic	4	010000	1	2	2	3	111		01	100		1	30	60	90				1	2			90				30		31	12.00	24.00	36.00																					24.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5945	001	0	1	01	01	H5945_001_0	12	Preferred Brand	4	000001	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												
H5945	001	0	1	01	01	H5945_001_0	12	Non-Preferred Brand	4	100000	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												
H5945	001	0	1	01	01	H5945_001_0	12	Specialty Tier	4	110001	1	1	5	1	010		10	010		1	30								30							10	31				670.00	33																				33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5945	002	0	1	01	01	H5945_002_0	12	Preferred Generic	4	001000	1	2	1	1	111		01	100		1	30	60	90				1	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												
H5945	002	0	1	01	01	H5945_002_0	12	Preferred Generic	4	001000	1	2	1	3	111		01	100		1	30	60	90				1	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										1		
H5945	002	0	1	01	01	H5945_002_0	12	Generic	4	010000	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	12.00	24.00	36.00																					24.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5945	002	0	1	01	01	H5945_002_0	12	Generic	4	010000	1	2	2	3	111		01	100		1	30	60	90				1	2			90				30		31	12.00	24.00	36.00																					24.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H5945	002	0	1	01	01	H5945_002_0	12	Preferred Brand	4	000001	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												
H5945	002	0	1	01	01	H5945_002_0	12	Non-Preferred Brand	4	100000	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												
H5945	002	0	1	01	01	H5945_002_0	12	Specialty Tier	4	110001	1	1	5	1	010		10	010		1	30								30							10	31				670.00	33																				33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H5970	001	0	1	04	01	H5970_001_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					8.00		24.00											10.00		30.00				8.00		0.00				10.00				10.00			0.33	0.27		0.33	0.27	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	001	0	1	04	01	H5970_001_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					8.00		24.00											10.00		30.00				8.00		0.00				10.00				10.00			0.33	0.27		0.33	0.27	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5970	001	0	1	04	01	H5970_001_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	001	0	1	04	01	H5970_001_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5970	001	0	1	04	01	H5970_001_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	001	0	1	04	01	H5970_001_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5970	001	0	1	04	01	H5970_001_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	001	0	1	04	01	H5970_001_0	4	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5970	001	0	1	04	01	H5970_001_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	001	0	1	04	01	H5970_001_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5970	008	0	1	04	01	H5970_008_0	8	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					8.00		24.00											10.00		30.00				8.00		0.00				10.00				10.00			0.33	0.27		0.33	0.27	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	008	0	1	04	01	H5970_008_0	8	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					8.00		24.00											10.00		30.00				8.00		0.00				10.00				10.00			0.33	0.27		0.33	0.27	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5970	008	0	1	04	01	H5970_008_0	8	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					18.00		54.00											20.00		60.00				18.00		0.00				20.00				20.00			0.67	0.60		0.67	0.60	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	008	0	1	04	01	H5970_008_0	8	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					18.00		54.00											20.00		60.00				18.00		0.00				20.00				20.00			0.67	0.60		0.67	0.60	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5970	008	0	1	04	01	H5970_008_0	8	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	008	0	1	04	01	H5970_008_0	8	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5970	008	0	1	04	01	H5970_008_0	8	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	008	0	1	04	01	H5970_008_0	8	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5970	008	0	1	04	01	H5970_008_0	8	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	008	0	1	04	01	H5970_008_0	8	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5970	014	1	1	04	01	H5970_014_1	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					10.00		30.00											10.00		30.00				10.00		0.00				10.00				10.00			0.33	0.33		0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	014	1	1	04	01	H5970_014_1	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					10.00		30.00											10.00		30.00				10.00		0.00				10.00				10.00			0.33	0.33		0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5970	014	1	1	04	01	H5970_014_1	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	014	1	1	04	01	H5970_014_1	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5970	014	1	1	04	01	H5970_014_1	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	014	1	1	04	01	H5970_014_1	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5970	014	1	1	04	01	H5970_014_1	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	014	1	1	04	01	H5970_014_1	4	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5970	014	1	1	04	01	H5970_014_1	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	014	1	1	04	01	H5970_014_1	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5970	014	2	1	04	01	H5970_014_2	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					10.00		30.00											10.00		30.00				10.00		0.00				10.00				10.00			0.33	0.33		0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	014	2	1	04	01	H5970_014_2	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					10.00		30.00											10.00		30.00				10.00		0.00				10.00				10.00			0.33	0.33		0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5970	014	2	1	04	01	H5970_014_2	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	014	2	1	04	01	H5970_014_2	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5970	014	2	1	04	01	H5970_014_2	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	014	2	1	04	01	H5970_014_2	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5970	014	2	1	04	01	H5970_014_2	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	014	2	1	04	01	H5970_014_2	4	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5970	014	2	1	04	01	H5970_014_2	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5970	014	2	1	04	01	H5970_014_2	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H5985	001	0	1	01	01	H5985_001_0	6	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5985	001	0	1	01	01	H5985_001_0	6	Preferred Generic	4	001000	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		
H5985	001	0	1	01	01	H5985_001_0	6	Generic	4	010000	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			.50			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5985	001	0	1	01	01	H5985_001_0	6	Preferred Brand	4	000001	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												
H5985	001	0	1	01	01	H5985_001_0	6	Non-Preferred Drug	4	100000	1	2	4	1	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												
H5985	001	0	1	01	01	H5985_001_0	6	Specialty Tier	4	110001	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												
H5985	005	0	1	01	01	H5985_005_0	15	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5985	005	0	1	01	01	H5985_005_0	15	Preferred Generic	4	001000	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		
H5985	005	0	1	01	01	H5985_005_0	15	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	25.00																10.00				10.00		0.33			.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5985	005	0	1	01	01	H5985_005_0	15	Preferred Brand	4	000001	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				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												
H5985	005	0	1	01	01	H5985_005_0	15	Non-Preferred Drug	4	100000	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	187.50																75.00				75.00		2.50			2.50			2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5985	005	0	1	01	01	H5985_005_0	15	Specialty Tier	4	110001	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												
H5989	002	0	1	01	01	H5989_002_0	2	Generic	3	010000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	9.00		27.00																					27.00																9.00				9.00		0.30						0.29	Generic, Brand												
H5989	002	0	1	01	01	H5989_002_0	2	Brand	3	000010	1	1	2	1	110		01	100		1	30		90				1	2			90				30		31				60.36	25		25																				25															25			25								Generic, Brand												
H5991	001	0	1	01	01	H5991_001_0	12	Preferred Generic	3	001000	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5991	001	0	1	01	01	H5991_001_0	12	Generic	3	010000	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	5.00	10.00	12.50																					12.50																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5991	001	0	1	01	01	H5991_001_0	12	Preferred Brand	3	000001	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	117.50																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5991	001	0	1	01	01	H5991_001_0	12	Non-Preferred Drug	3	100000	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	250.00																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5991	001	0	1	01	01	H5991_001_0	12	Specialty Tier	3	010010	1	1	5	1	010		01			1	30														30		31				562.50	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5991	002	0	1	01	01	H5991_002_0	11	Preferred Generic	3	001000	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5991	002	0	1	01	01	H5991_002_0	11	Generic	3	010000	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	7.00	14.00	17.50																					17.50																7.00				7.00		0.23						0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5991	002	0	1	01	01	H5991_002_0	11	Preferred Brand	3	000001	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	117.50																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5991	002	0	1	01	01	H5991_002_0	11	Non-Preferred Drug	3	100000	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	250.00																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5991	002	0	1	01	01	H5991_002_0	11	Specialty Tier	3	010010	1	1	5	1	010		01			1	30														30		31				562.50	25																																					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5991	003	0	1	01	01	H5991_003_0	12	Preferred Generic	4	001000	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5991	003	0	1	01	01	H5991_003_0	12	Preferred Generic	4	001000	1	2	1	3	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5991	003	0	1	01	01	H5991_003_0	12	Generic	4	010000	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	25.00																					25.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5991	003	0	1	01	01	H5991_003_0	12	Preferred Brand	4	000001	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	117.50																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5991	003	0	1	01	01	H5991_003_0	12	Non-Preferred Drug	4	100000	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	250.00																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5991	003	0	1	01	01	H5991_003_0	12	Specialty Tier	4	010010	1	1	5	1	010		01			1	30														30		31				585.00	28																																					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5991	004	0	1	01	01	H5991_004_0	12	Preferred Generic	4	001000	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5991	004	0	1	01	01	H5991_004_0	12	Preferred Generic	4	001000	1	2	1	3	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5991	004	0	1	01	01	H5991_004_0	12	Generic	4	010000	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	8.00	16.00	20.00																					20.00																8.00				8.00		0.27						0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5991	004	0	1	01	01	H5991_004_0	12	Preferred Brand	4	000001	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	42.00	84.00	105.00																					105.00																42.00				42.00		1.40						1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5991	004	0	1	01	01	H5991_004_0	12	Non-Preferred Drug	4	100000	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	95.00	190.00	237.50																					237.50																95.00				95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5991	004	0	1	01	01	H5991_004_0	12	Specialty Tier	4	010010	1	1	5	1	010		01			1	30														30		31				742.50	33																																					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5991	006	0	1	01	01	H5991_006_0	8	Preferred Generic	4	001000	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5991	006	0	1	01	01	H5991_006_0	8	Preferred Generic	4	001000	1	2	1	3	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H5991	006	0	1	01	01	H5991_006_0	8	Generic	4	010000	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	25.00																					25.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5991	006	0	1	01	01	H5991_006_0	8	Preferred Brand	4	000001	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	117.50																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5991	006	0	1	01	01	H5991_006_0	8	Non-Preferred Drug	4	100000	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	250.00																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H5991	006	0	1	01	01	H5991_006_0	8	Specialty Tier	4	010010	1	1	5	1	010		01			1	30														30		31				652.50	27																																					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6080	001	0	1	48	05	H6080_001_0	4	Generic Drugs	4	010000			1	1	110		01	100		1	30		90				2	2			90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	3.30	0.00	3.30			0.00	3.30			
H6080	001	0	1	48	05	H6080_001_0	4	Brand Drugs	4	000010			2	1	110		01	100		1	30		90				2	2			90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	8.25	0.00	8.25			0.00	8.25			
H6080	001	0	1	48	05	H6080_001_0	4	Non-Medicare Rx/OTC Drugs	4	010010			3	1	110		01	100		1	30		90				1	1			90				30		31																																														0.00						0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H6229	005	0	1	48	05	H6229_005_0	8	Generic Drugs	4	010000			1	1	111		10	111		1	31	62	93				2	2	31	62	93					10	31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H6229	005	0	1	48	05	H6229_005_0	8	Brand Drugs	4	000010			2	1	111		10	111		1	31	62	93				2	2	31	62	93					10	31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H6229	005	0	1	48	05	H6229_005_0	8	Non-Medicare Rx Drugs	4	010010			3	1	010		10			1	31															10	31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	2	0.00	0.00	0.00	0.00			0.00	0.00			
H6229	005	0	1	48	05	H6229_005_0	8	Non-Medicare OTC Drugs	4	010010			4	1	010		10			1	31															10	31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	2	0.00	0.00	0.00	0.00			0.00	0.00			
H6229	006	0	1	48	05	H6229_006_0	8	Generic Drugs	4	010010			1	1	111		10	111		1	31	62	93				2	2	31	62	93					10	31																																														0.00			0.00			0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H6229	006	0	1	48	05	H6229_006_0	8	Brand Drugs	4	010010			2	1	111		10	111		1	31	62	93				2	2	31	62	93					10	31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	0.00	8.25			0.00	8.25	0.00	8.25			
H6229	006	0	1	48	05	H6229_006_0	8	Non-Medicare Rx Drugs	4	010010			3	1	010		10			1	31															10	31																																														0.00						0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	2	0.00	0.00	0.00	0.00			0.00	0.00			
H6229	006	0	1	48	05	H6229_006_0	8	Non-Medicare OTC Drugs	4	010010			4	1	010		10			1	31															10	31																																														0.00						0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	2	0.00	0.00	0.00	0.00			0.00	0.00			
H6237	003	1	1	01	01	H6237_003_1	9	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	6.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6237	003	1	1	01	01	H6237_003_1	9	Generic	4	010000	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, Select Care Drugs												
H6237	003	1	1	01	01	H6237_003_1	9	Preferred Brand	4	000001	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, Select Care Drugs												
H6237	003	1	1	01	01	H6237_003_1	9	Non-Preferred Drug	4	100100	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				76.00	40	40	40																		40	40	40															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6237	003	1	1	01	01	H6237_003_1	9	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31				1230.90	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6237	003	1	1	01	01	H6237_003_1	9	Select Care Drugs	4	010000	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6237	003	2	1	01	01	H6237_003_2	9	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	6.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6237	003	2	1	01	01	H6237_003_2	9	Generic	4	010000	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, Select Care Drugs												
H6237	003	2	1	01	01	H6237_003_2	9	Preferred Brand	4	000001	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, Select Care Drugs												
H6237	003	2	1	01	01	H6237_003_2	9	Non-Preferred Drug	4	100100	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				76.00	40	40	40																		40	40	40															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6237	003	2	1	01	01	H6237_003_2	9	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31				1230.90	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6237	003	2	1	01	01	H6237_003_2	9	Select Care Drugs	4	010000	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6298	010	1	1	01	01	H6298_010_1	10	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	8.00	10.00																			5.00	8.00	10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6298	010	1	1	01	01	H6298_010_1	10	Preferred Generic	4	001000	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	8.00	10.00																			5.00	8.00	10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6298	010	1	1	01	01	H6298_010_1	10	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	19.00	29.00	38.00																			19.00	29.00	38.00																19.00				19.00		0.63			0.63			0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6298	010	1	1	01	01	H6298_010_1	10	Generic	4	010000	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	19.00	29.00	38.00																			19.00	29.00	38.00																19.00				19.00		0.63			0.63			0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6298	010	1	1	01	01	H6298_010_1	10	Preferred Brand	4	000001	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 Drug, Specialty Tier												
H6298	010	1	1	01	01	H6298_010_1	10	Non-Preferred Drug	4	110000	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				48.03	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6298	010	1	1	01	01	H6298_010_1	10	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31					29																				29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6298	010	2	1	01	01	H6298_010_2	9	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	8.00	10.00																			5.00	8.00	10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6298	010	2	1	01	01	H6298_010_2	9	Preferred Generic	4	001000	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	8.00	10.00																			5.00	8.00	10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6298	010	2	1	01	01	H6298_010_2	9	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	19.00	29.00	38.00																			19.00	29.00	38.00																19.00				19.00		0.63			0.63			0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6298	010	2	1	01	01	H6298_010_2	9	Generic	4	010000	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	19.00	29.00	38.00																			19.00	29.00	38.00																19.00				19.00		0.63			0.63			0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6298	010	2	1	01	01	H6298_010_2	9	Preferred Brand	4	000001	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 Drug, Specialty Tier												
H6298	010	2	1	01	01	H6298_010_2	9	Non-Preferred Drug	4	110000	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				48.03	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6298	010	2	1	01	01	H6298_010_2	9	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31					29																				29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6298	011	1	1	01	01	H6298_011_1	8	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6298	011	1	1	01	01	H6298_011_1	8	Preferred Generic	4	001000	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		
H6298	011	1	1	01	01	H6298_011_1	8	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	14.00	21.00	28.00																			14.00	21.00	28.00																14.00				14.00		0.47			0.47			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6298	011	1	1	01	01	H6298_011_1	8	Generic	4	010000	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	14.00	21.00	28.00																			14.00	21.00	28.00																14.00				14.00		0.47			0.47			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6298	011	1	1	01	01	H6298_011_1	8	Preferred Brand	4	000001	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 Drug, Specialty Tier												
H6298	011	1	1	01	01	H6298_011_1	8	Non-Preferred Drug	4	110000	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				12.65	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6298	011	1	1	01	01	H6298_011_1	8	Specialty Tier	4	010010	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												
H6298	011	2	1	01	01	H6298_011_2	8	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6298	011	2	1	01	01	H6298_011_2	8	Preferred Generic	4	001000	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		
H6298	011	2	1	01	01	H6298_011_2	8	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	14.00	21.00	28.00																			14.00	21.00	28.00																14.00				14.00		0.47			0.47			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6298	011	2	1	01	01	H6298_011_2	8	Generic	4	010000	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	14.00	21.00	28.00																			14.00	21.00	28.00																14.00				14.00		0.47			0.47			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6298	011	2	1	01	01	H6298_011_2	8	Preferred Brand	4	000001	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 Drug, Specialty Tier												
H6298	011	2	1	01	01	H6298_011_2	8	Non-Preferred Drug	4	110000	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				12.65	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6298	011	2	1	01	01	H6298_011_2	8	Specialty Tier	4	010010	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												
H6298	012	1	1	01	01	H6298_012_1	8	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6298	012	1	1	01	01	H6298_012_1	8	Preferred Generic	4	001000	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		
H6298	012	1	1	01	01	H6298_012_1	8	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	14.00	21.00	28.00																			14.00	21.00	28.00																14.00				14.00		0.47			0.47			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6298	012	1	1	01	01	H6298_012_1	8	Generic	4	010000	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	14.00	21.00	28.00																			14.00	21.00	28.00																14.00				14.00		0.47			0.47			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6298	012	1	1	01	01	H6298_012_1	8	Preferred Brand	4	000001	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 Drug, Specialty Tier												
H6298	012	1	1	01	01	H6298_012_1	8	Non-Preferred Drug	4	110000	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				14.51	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6298	012	1	1	01	01	H6298_012_1	8	Specialty Tier	4	010010	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												
H6298	012	2	1	01	01	H6298_012_2	8	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6298	012	2	1	01	01	H6298_012_2	8	Preferred Generic	4	001000	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		
H6298	012	2	1	01	01	H6298_012_2	8	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	14.00	21.00	28.00																			14.00	21.00	28.00																14.00				14.00		0.47			0.47			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6298	012	2	1	01	01	H6298_012_2	8	Generic	4	010000	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	14.00	21.00	28.00																			14.00	21.00	28.00																14.00				14.00		0.47			0.47			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6298	012	2	1	01	01	H6298_012_2	8	Preferred Brand	4	000001	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 Drug, Specialty Tier												
H6298	012	2	1	01	01	H6298_012_2	8	Non-Preferred Drug	4	110000	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				14.51	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6298	012	2	1	01	01	H6298_012_2	8	Specialty Tier	4	010010	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												
H6306	002	0	1	01	01	H6306_002_0	8	Preferred Generic	4	101001	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	6.00	12.00	18.00																			6.00	0.00	0.00																6.00				6.00		0.20			0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6306	002	0	1	01	01	H6306_002_0	8	Preferred Generic	4	101001	1	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				6.00		0.20			0.00			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H6306	002	0	1	01	01	H6306_002_0	8	Generic	4	110001	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 Brand, Specialty Tier												
H6306	002	0	1	01	01	H6306_002_0	8	Preferred Brand	4	110001	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6306	002	0	1	01	01	H6306_002_0	8	Non-Preferred Brand	4	110001	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	225.00																90.00				90.00		3.00			3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6306	002	0	1	01	01	H6306_002_0	8	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31				750.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6306	003	0	1	01	01	H6306_003_0	6	Preferred Generic	4	101001	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	9.00	18.00	27.00																			3.00	3.00	3.00																9.00				9.00		0.30			0.10			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6306	003	0	1	01	01	H6306_003_0	6	Preferred Generic	4	101001	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	9.00	18.00	27.00																			3.00	3.00	3.00																9.00				9.00		0.30			0.10			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H6306	003	0	1	01	01	H6306_003_0	6	Generic	4	110001	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 Brand, Specialty Tier												
H6306	003	0	1	01	01	H6306_003_0	6	Preferred Brand	4	110001	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6306	003	0	1	01	01	H6306_003_0	6	Non-Preferred Brand	4	110001	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	225.00																90.00				90.00		3.00			3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6306	003	0	1	01	01	H6306_003_0	6	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31				612.50	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6306	005	0	1	01	01	H6306_005_0	6	Preferred Generic	4	101001	1	2	1	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6306	005	0	1	01	01	H6306_005_0	6	Preferred Generic	4	101001	1	2	1	3	111		10	111		1	30	60	100				1	2	30	60	100					10	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H6306	005	0	1	01	01	H6306_005_0	6	Generic	4	110001	1	2	2	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	10.00	20.00	30.00																			10.00	20.00	30.00																	10.00			10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6306	005	0	1	01	01	H6306_005_0	6	Preferred Brand	4	110001	1	2	3	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	47.00	94.00	141.00																			47.00	94.00	141.00																	47.00			47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6306	005	0	1	01	01	H6306_005_0	6	Non-Preferred Brand	4	110001	1	2	4	1	111		10	111		1	30	60	100				1	2	30	60	100					10	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6306	005	0	1	01	01	H6306_005_0	6	Specialty Tier	4	010010	1	1	5	1	010		10	010		1	30								30							10	31				750.00	33																				33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6306	007	0	1	01	01	H6306_007_0	8	Preferred Generic	4	101001	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	6.00	12.00	18.00																			6.00	0.00	0.00																6.00				6.00		0.20			0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6306	007	0	1	01	01	H6306_007_0	8	Preferred Generic	4	101001	1	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				6.00		0.20			0.00			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H6306	007	0	1	01	01	H6306_007_0	8	Generic	4	110001	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 Brand, Specialty Tier												
H6306	007	0	1	01	01	H6306_007_0	8	Preferred Brand	4	110001	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6306	007	0	1	01	01	H6306_007_0	8	Non-Preferred Brand	4	110001	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	225.00																90.00				90.00		3.00			3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6306	007	0	1	01	01	H6306_007_0	8	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31				750.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6308	001	0	1	48	05	H6308_001_0	5	Generic Drugs	4	010000			1	1	111		01	100		1	30	60	90				1	2			90				30		31																																														0.00						0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H6308	001	0	1	48	05	H6308_001_0	5	Brand Drugs	4	000010			2	1	111		01	100		1	30	60	90				1	2			90				30		31																																														0.00						0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H6308	001	0	1	48	05	H6308_001_0	5	Non-Medicare Rx/OTC Drugs	4	010010			3	1	111		01	100		1	30	60	90				1	2			90				30		31																																														0.00						0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H6320	001	0	1	01	01	H6320_001_0	7	Preferred Generic	4	001000	1	2	1	1	110		10	100		1	31		90				1	2			90					10	31	0.00		0.00																					0.00																	0.00			0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6320	001	0	1	01	01	H6320_001_0	7	Generic	4	010000	1	1	2	1	110		10	100		1	31		90				1	2			90					10	31				14.90	25		25																				25																25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6320	001	0	1	01	01	H6320_001_0	7	Preferred Brand	4	000001	1	1	3	1	110		10	100		1	31		90				1	2			90					10	31				67.40	25		25																				25																25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6320	001	0	1	01	01	H6320_001_0	7	Non-Preferred Brand	4	100000	1	1	4	1	110		10	100		1	31		90				1	2			90					10	31				188.71	25		25																				25																25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6320	001	0	1	01	01	H6320_001_0	7	Specialty Tier	4	010010	1	1	5	1	010		10	010		1	31								30							10	31				600.00	25																				25																		25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6328	001	0	1	04	01	H6328_001_0	8	Preferred Generic	4	001000	1	2	1	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6328	001	0	1	04	01	H6328_001_0	8	Generic	4	010010	1	2	2	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	10.00	20.00	20.00																			10.00	20.00	20.00																	10.00			10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6328	001	0	1	04	01	H6328_001_0	8	Preferred Brand	4	010001	1	2	3	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	40.00	80.00	80.00																			40.00	80.00	80.00																	40.00			40.00		1.33			1.33			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6328	001	0	1	04	01	H6328_001_0	8	Non-Preferred Drug	4	110000	1	2	4	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	85.00	170.00	170.00																			85.00	170.00	170.00																	85.00			85.00		2.83			2.83			2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6328	001	0	1	04	01	H6328_001_0	8	Specialty Tier	4	010010	1	1	5	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31				1098.30	33	33	33																		33	33	33																33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6328	002	0	1	04	01	H6328_002_0	7	Preferred Generic	4	001000	1	2	1	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	0.00	0.00	0.00																			0.00	0.00	0.00																	0.00			0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6328	002	0	1	04	01	H6328_002_0	7	Generic	4	010010	1	2	2	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	12.00	24.00	24.00																			12.00	24.00	24.00																	12.00			12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6328	002	0	1	04	01	H6328_002_0	7	Preferred Brand	4	010001	1	2	3	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	45.00	90.00	90.00																			45.00	90.00	90.00																	45.00			45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6328	002	0	1	04	01	H6328_002_0	7	Non-Preferred Drug	4	110000	1	2	4	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	90.00	180.00	180.00																			90.00	180.00	180.00																	90.00			90.00		3.00			3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6328	002	0	1	04	01	H6328_002_0	7	Specialty Tier	4	010010	1	1	5	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31				1103.63	33	33	33																		33	33	33																33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6328	003	0	1	04	01	H6328_003_0	8	Preferred Generic	4	001000	1	2	1	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	4.00	8.00	8.00																			4.00	8.00	8.00																	4.00			4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6328	003	0	1	04	01	H6328_003_0	8	Generic	4	010010	1	2	2	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	15.00	30.00	30.00																			15.00	30.00	30.00																	15.00			15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6328	003	0	1	04	01	H6328_003_0	8	Preferred Brand	4	010001	1	2	3	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	45.00	90.00	90.00																			45.00	90.00	90.00																	45.00			45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6328	003	0	1	04	01	H6328_003_0	8	Non-Preferred Drug	4	110000	1	2	4	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	100.00	200.00	200.00																			100.00	200.00	200.00																	100.00			100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6328	003	0	1	04	01	H6328_003_0	8	Specialty Tier	4	010010	1	1	5	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31				942.51	33	33	33																		33	33	33																33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6396	001	0	1	01	01	H6396_001_0	8	Preferred Generic	4	001001	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	4.00		12.00																					10.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6396	001	0	1	01	01	H6396_001_0	8	Generic	4	010001	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	10.00		30.00																					25.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6396	001	0	1	01	01	H6396_001_0	8	Preferred Brand	4	000101	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		141.00																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6396	001	0	1	01	01	H6396_001_0	8	Non-Preferred Drug	4	100100	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		300.00																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6396	001	0	1	01	01	H6396_001_0	8	Specialty Tier	4	010010	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31					33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6396	002	0	1	01	01	H6396_002_0	5	Preferred Generic	4	001001	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6396	002	0	1	01	01	H6396_002_0	5	Generic	4	010001	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	10.00		30.00																					25.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6396	002	0	1	01	01	H6396_002_0	5	Preferred Brand	4	000101	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		141.00																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6396	002	0	1	01	01	H6396_002_0	5	Non-Preferred Drug	4	100100	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		300.00																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6396	002	0	1	01	01	H6396_002_0	5	Specialty Tier	4	010010	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31					33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6396	004	0	1	01	01	H6396_004_0	4	Preferred Generic	4	001001	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	6.00		18.00																					15.00																6.00				6.00		0.20						0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6396	004	0	1	01	01	H6396_004_0	4	Generic	4	010001	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	15.00		45.00																					37.50																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6396	004	0	1	01	01	H6396_004_0	4	Preferred Brand	4	000101	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		141.00																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6396	004	0	1	01	01	H6396_004_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		300.00																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6396	004	0	1	01	01	H6396_004_0	4	Specialty Tier	4	010010	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31					28		28																				28															28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6435	001	0	1	48	05	H6435_001_0	4	Generic Drugs	4	010000			1	1	110		01	100		1	31		90				2	2			90				31		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			
H6435	001	0	1	48	05	H6435_001_0	4	Brand Drugs	4	000010			2	1	110		01	100		1	31		90				2	2			90				31		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			
H6435	001	0	1	48	05	H6435_001_0	4	Non-Medicare Rx/OTC Drugs	4	010010			3	1	110		01	100		1	31		90				1	2			90				31		31																																														0.00						0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H6453	001	0	1	01	01	H6453_001_0	4	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6453	001	0	1	01	01	H6453_001_0	4	Preferred Generic	4	001000	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6453	001	0	1	01	01	H6453_001_0	4	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	12.00	24.00	36.00																			12.00	24.00	24.00																12.00				12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6453	001	0	1	01	01	H6453_001_0	4	Generic	4	010000	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	12.00	24.00	36.00																			12.00	24.00	24.00																12.00				12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6453	001	0	1	01	01	H6453_001_0	4	Preferred Brand	4	000001	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												
H6453	001	0	1	01	01	H6453_001_0	4	Non-Preferred Drug	4	100000	1	2	4	1	111		01	111		1	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												
H6453	001	0	1	01	01	H6453_001_0	4	Specialty Tier	4	010010	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												
H6453	002	0	1	01	01	H6453_002_0	4	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6453	002	0	1	01	01	H6453_002_0	4	Preferred Generic	4	001000	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6453	002	0	1	01	01	H6453_002_0	4	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6453	002	0	1	01	01	H6453_002_0	4	Generic	4	010000	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	20.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6453	002	0	1	01	01	H6453_002_0	4	Preferred Brand	4	000001	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												
H6453	002	0	1	01	01	H6453_002_0	4	Non-Preferred Drug	4	100000	1	2	4	1	111		01	111		1	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												
H6453	002	0	1	01	01	H6453_002_0	4	Specialty Tier	4	010010	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												
H6453	003	0	1	01	01	H6453_003_0	4	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6453	003	0	1	01	01	H6453_003_0	4	Preferred Generic	4	001000	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6453	003	0	1	01	01	H6453_003_0	4	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	12.00	24.00	36.00																			12.00	24.00	24.00																12.00				12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6453	003	0	1	01	01	H6453_003_0	4	Generic	4	010000	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	12.00	24.00	36.00																			12.00	24.00	24.00																12.00				12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6453	003	0	1	01	01	H6453_003_0	4	Preferred Brand	4	000001	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												
H6453	003	0	1	01	01	H6453_003_0	4	Non-Preferred Drug	4	100000	1	2	4	1	111		01	111		1	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												
H6453	003	0	1	01	01	H6453_003_0	4	Specialty Tier	4	010010	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												
H6453	004	0	1	01	01	H6453_004_0	4	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6453	004	0	1	01	01	H6453_004_0	4	Preferred Generic	4	001000	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	6.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6453	004	0	1	01	01	H6453_004_0	4	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	12.00	24.00	36.00																			12.00	24.00	24.00																12.00				12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6453	004	0	1	01	01	H6453_004_0	4	Generic	4	010000	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	12.00	24.00	36.00																			12.00	24.00	24.00																12.00				12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6453	004	0	1	01	01	H6453_004_0	4	Preferred Brand	4	000001	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												
H6453	004	0	1	01	01	H6453_004_0	4	Non-Preferred Drug	4	100000	1	2	4	1	111		01	111		1	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												
H6453	004	0	1	01	01	H6453_004_0	4	Specialty Tier	4	010010	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												
H6528	006	0	1	04	01	H6528_006_0	4	Preferred Generic	3	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6528	006	0	1	04	01	H6528_006_0	4	Generic	3	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6528	006	0	1	04	01	H6528_006_0	4	Preferred Brand	3	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6528	006	0	1	04	01	H6528_006_0	4	Non-Preferred Drug	3	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6528	006	0	1	04	01	H6528_006_0	4	Specialty Tier	3	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				869.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	001	0	1	04	01	H6609_001_0	6	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	001	0	1	04	01	H6609_001_0	6	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	001	0	1	04	01	H6609_001_0	6	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	001	0	1	04	01	H6609_001_0	6	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	001	0	1	04	01	H6609_001_0	6	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	001	0	1	04	01	H6609_001_0	6	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	001	0	1	04	01	H6609_001_0	6	Non-Preferred Drug	4	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											67.00	50		50				66.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	001	0	1	04	01	H6609_001_0	6	Non-Preferred Drug	4	110000	1	1	4	3		110	01		110	1				30		90	2	2				30		90	30		31											68.00	31		31				67.00	31		31										31		31				31		31			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	001	0	1	04	01	H6609_001_0	6	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	001	0	1	04	01	H6609_001_0	6	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	003	0	1	04	01	H6609_003_0	3	Preferred Generic	3	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								7.00		21.00					2.00		6.00											7.00		21.00				2.00		0.00				7.00				7.00			0.23	0.07		0.23	0.07	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	003	0	1	04	01	H6609_003_0	3	Generic	3	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	003	0	1	04	01	H6609_003_0	3	Preferred Brand	3	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	003	0	1	04	01	H6609_003_0	3	Non-Preferred Drug	3	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											100.00	50		50				99.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	003	0	1	04	01	H6609_003_0	3	Specialty Tier	3	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	009	0	1	04	01	H6609_009_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								9.00		27.00					4.00		12.00											9.00		27.00				4.00		0.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	009	0	1	04	01	H6609_009_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								9.00		27.00					4.00		12.00											9.00		27.00				4.00		0.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	009	0	1	04	01	H6609_009_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	009	0	1	04	01	H6609_009_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	009	0	1	04	01	H6609_009_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	009	0	1	04	01	H6609_009_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	009	0	1	04	01	H6609_009_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	009	0	1	04	01	H6609_009_0	4	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	009	0	1	04	01	H6609_009_0	4	Specialty Tier	4	010010	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												
H6609	009	0	1	04	01	H6609_009_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	013	0	1	04	01	H6609_013_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								9.00		27.00					4.00		12.00											9.00		27.00				4.00		0.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	013	0	1	04	01	H6609_013_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								9.00		27.00					4.00		12.00											9.00		27.00				4.00		0.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	013	0	1	04	01	H6609_013_0	3	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	013	0	1	04	01	H6609_013_0	3	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	013	0	1	04	01	H6609_013_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	013	0	1	04	01	H6609_013_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	013	0	1	04	01	H6609_013_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	013	0	1	04	01	H6609_013_0	3	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	013	0	1	04	01	H6609_013_0	3	Specialty Tier	4	010010	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												
H6609	013	0	1	04	01	H6609_013_0	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	017	0	1	04	01	H6609_017_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	017	0	1	04	01	H6609_017_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	017	0	1	04	01	H6609_017_0	3	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	017	0	1	04	01	H6609_017_0	3	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	017	0	1	04	01	H6609_017_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	017	0	1	04	01	H6609_017_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	017	0	1	04	01	H6609_017_0	3	Non-Preferred Drug	4	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											65.00	50		50				64.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	017	0	1	04	01	H6609_017_0	3	Non-Preferred Drug	4	110000	1	1	4	3		110	01		110	1				30		90	2	2				30		90	30		31											68.00	31		31				67.00	31		31										31		31				31		31			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	017	0	1	04	01	H6609_017_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	017	0	1	04	01	H6609_017_0	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	019	0	1	04	01	H6609_019_0	6	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	019	0	1	04	01	H6609_019_0	6	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	019	0	1	04	01	H6609_019_0	6	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	019	0	1	04	01	H6609_019_0	6	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	019	0	1	04	01	H6609_019_0	6	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	019	0	1	04	01	H6609_019_0	6	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	019	0	1	04	01	H6609_019_0	6	Non-Preferred Drug	4	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											60.00	50		50				60.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	019	0	1	04	01	H6609_019_0	6	Non-Preferred Drug	4	110000	1	1	4	3		110	01		110	1				30		90	2	2				30		90	30		31											57.00	31		31				56.00	31		31										31		31				31		31			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	019	0	1	04	01	H6609_019_0	6	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	019	0	1	04	01	H6609_019_0	6	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	029	0	1	04	01	H6609_029_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								9.00		27.00					4.00		12.00											9.00		27.00				4.00		0.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	029	0	1	04	01	H6609_029_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								9.00		27.00					4.00		12.00											9.00		27.00				4.00		0.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	029	0	1	04	01	H6609_029_0	3	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	029	0	1	04	01	H6609_029_0	3	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	029	0	1	04	01	H6609_029_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	029	0	1	04	01	H6609_029_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	029	0	1	04	01	H6609_029_0	3	Non-Preferred Drug	4	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											94.00	50		50				93.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	029	0	1	04	01	H6609_029_0	3	Non-Preferred Drug	4	110000	1	1	4	3		110	01		110	1				30		90	2	2				30		90	30		31											91.00	31		31				91.00	31		31										31		31				31		31			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	029	0	1	04	01	H6609_029_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	029	0	1	04	01	H6609_029_0	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	073	0	1	04	01	H6609_073_0	3	Preferred Generic	3	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								9.00		27.00					4.00		12.00											9.00		27.00				4.00		0.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	073	0	1	04	01	H6609_073_0	3	Generic	3	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	073	0	1	04	01	H6609_073_0	3	Preferred Brand	3	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	073	0	1	04	01	H6609_073_0	3	Non-Preferred Drug	3	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	073	0	1	04	01	H6609_073_0	3	Specialty Tier	3	010010	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												
H6609	077	0	1	04	01	H6609_077_0	7	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	077	0	1	04	01	H6609_077_0	7	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	077	0	1	04	01	H6609_077_0	7	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	077	0	1	04	01	H6609_077_0	7	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	077	0	1	04	01	H6609_077_0	7	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	077	0	1	04	01	H6609_077_0	7	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	077	0	1	04	01	H6609_077_0	7	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	077	0	1	04	01	H6609_077_0	7	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	077	0	1	04	01	H6609_077_0	7	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	077	0	1	04	01	H6609_077_0	7	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	078	0	1	04	01	H6609_078_0	7	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	078	0	1	04	01	H6609_078_0	7	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	078	0	1	04	01	H6609_078_0	7	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	078	0	1	04	01	H6609_078_0	7	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	078	0	1	04	01	H6609_078_0	7	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	078	0	1	04	01	H6609_078_0	7	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	078	0	1	04	01	H6609_078_0	7	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	078	0	1	04	01	H6609_078_0	7	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	078	0	1	04	01	H6609_078_0	7	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	078	0	1	04	01	H6609_078_0	7	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	080	0	1	04	01	H6609_080_0	6	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	080	0	1	04	01	H6609_080_0	6	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	080	0	1	04	01	H6609_080_0	6	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								17.00		51.00					12.00		36.00											17.00		51.00				12.00		0.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	080	0	1	04	01	H6609_080_0	6	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								17.00		51.00					12.00		36.00											17.00		51.00				12.00		0.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	080	0	1	04	01	H6609_080_0	6	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	080	0	1	04	01	H6609_080_0	6	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	080	0	1	04	01	H6609_080_0	6	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	080	0	1	04	01	H6609_080_0	6	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	080	0	1	04	01	H6609_080_0	6	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	080	0	1	04	01	H6609_080_0	6	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	081	0	1	04	01	H6609_081_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	081	0	1	04	01	H6609_081_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	081	0	1	04	01	H6609_081_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	081	0	1	04	01	H6609_081_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	081	0	1	04	01	H6609_081_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	081	0	1	04	01	H6609_081_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	081	0	1	04	01	H6609_081_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	081	0	1	04	01	H6609_081_0	4	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	081	0	1	04	01	H6609_081_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	081	0	1	04	01	H6609_081_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	082	0	1	04	01	H6609_082_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	082	0	1	04	01	H6609_082_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	082	0	1	04	01	H6609_082_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	082	0	1	04	01	H6609_082_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	082	0	1	04	01	H6609_082_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	082	0	1	04	01	H6609_082_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	082	0	1	04	01	H6609_082_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	082	0	1	04	01	H6609_082_0	4	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	082	0	1	04	01	H6609_082_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	082	0	1	04	01	H6609_082_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	083	0	1	04	01	H6609_083_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	083	0	1	04	01	H6609_083_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	083	0	1	04	01	H6609_083_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	083	0	1	04	01	H6609_083_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	083	0	1	04	01	H6609_083_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	083	0	1	04	01	H6609_083_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	083	0	1	04	01	H6609_083_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	083	0	1	04	01	H6609_083_0	4	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	083	0	1	04	01	H6609_083_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	083	0	1	04	01	H6609_083_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	084	0	1	04	01	H6609_084_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	084	0	1	04	01	H6609_084_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	084	0	1	04	01	H6609_084_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	084	0	1	04	01	H6609_084_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	084	0	1	04	01	H6609_084_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	084	0	1	04	01	H6609_084_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	084	0	1	04	01	H6609_084_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	084	0	1	04	01	H6609_084_0	4	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	084	0	1	04	01	H6609_084_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	084	0	1	04	01	H6609_084_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	085	0	1	04	01	H6609_085_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	085	0	1	04	01	H6609_085_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	085	0	1	04	01	H6609_085_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	085	0	1	04	01	H6609_085_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	085	0	1	04	01	H6609_085_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	085	0	1	04	01	H6609_085_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	085	0	1	04	01	H6609_085_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	085	0	1	04	01	H6609_085_0	4	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	085	0	1	04	01	H6609_085_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	085	0	1	04	01	H6609_085_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	088	0	1	04	01	H6609_088_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	088	0	1	04	01	H6609_088_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	088	0	1	04	01	H6609_088_0	3	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	088	0	1	04	01	H6609_088_0	3	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	088	0	1	04	01	H6609_088_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	088	0	1	04	01	H6609_088_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	088	0	1	04	01	H6609_088_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	088	0	1	04	01	H6609_088_0	3	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	088	0	1	04	01	H6609_088_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	088	0	1	04	01	H6609_088_0	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	089	0	1	04	01	H6609_089_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	089	0	1	04	01	H6609_089_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	089	0	1	04	01	H6609_089_0	3	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	089	0	1	04	01	H6609_089_0	3	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	089	0	1	04	01	H6609_089_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	089	0	1	04	01	H6609_089_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	089	0	1	04	01	H6609_089_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	089	0	1	04	01	H6609_089_0	3	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	089	0	1	04	01	H6609_089_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	089	0	1	04	01	H6609_089_0	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	090	0	1	04	01	H6609_090_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	090	0	1	04	01	H6609_090_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	090	0	1	04	01	H6609_090_0	3	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	090	0	1	04	01	H6609_090_0	3	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	090	0	1	04	01	H6609_090_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	090	0	1	04	01	H6609_090_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	090	0	1	04	01	H6609_090_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	090	0	1	04	01	H6609_090_0	3	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	090	0	1	04	01	H6609_090_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	090	0	1	04	01	H6609_090_0	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	091	0	1	04	01	H6609_091_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	091	0	1	04	01	H6609_091_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	091	0	1	04	01	H6609_091_0	3	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	091	0	1	04	01	H6609_091_0	3	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	091	0	1	04	01	H6609_091_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	091	0	1	04	01	H6609_091_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	091	0	1	04	01	H6609_091_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	091	0	1	04	01	H6609_091_0	3	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	091	0	1	04	01	H6609_091_0	3	Specialty Tier	4	010010	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												
H6609	091	0	1	04	01	H6609_091_0	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	092	0	1	04	01	H6609_092_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	092	0	1	04	01	H6609_092_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	092	0	1	04	01	H6609_092_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	092	0	1	04	01	H6609_092_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	092	0	1	04	01	H6609_092_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	092	0	1	04	01	H6609_092_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	092	0	1	04	01	H6609_092_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	092	0	1	04	01	H6609_092_0	4	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	092	0	1	04	01	H6609_092_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	092	0	1	04	01	H6609_092_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	095	0	1	04	01	H6609_095_0	5	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	095	0	1	04	01	H6609_095_0	5	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	095	0	1	04	01	H6609_095_0	5	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	095	0	1	04	01	H6609_095_0	5	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	095	0	1	04	01	H6609_095_0	5	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	095	0	1	04	01	H6609_095_0	5	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	095	0	1	04	01	H6609_095_0	5	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	095	0	1	04	01	H6609_095_0	5	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	095	0	1	04	01	H6609_095_0	5	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	095	0	1	04	01	H6609_095_0	5	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	096	0	1	04	01	H6609_096_0	5	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	096	0	1	04	01	H6609_096_0	5	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	096	0	1	04	01	H6609_096_0	5	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	096	0	1	04	01	H6609_096_0	5	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	096	0	1	04	01	H6609_096_0	5	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	096	0	1	04	01	H6609_096_0	5	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	096	0	1	04	01	H6609_096_0	5	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	096	0	1	04	01	H6609_096_0	5	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	096	0	1	04	01	H6609_096_0	5	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	096	0	1	04	01	H6609_096_0	5	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	097	0	1	04	01	H6609_097_0	4	Preferred Generic	3	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	097	0	1	04	01	H6609_097_0	4	Generic	3	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	097	0	1	04	01	H6609_097_0	4	Preferred Brand	3	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	097	0	1	04	01	H6609_097_0	4	Non-Preferred Drug	3	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	097	0	1	04	01	H6609_097_0	4	Specialty Tier	3	010010	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												
H6609	100	0	1	04	01	H6609_100_0	5	Preferred Generic	3	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					8.00		24.00											10.00		30.00				8.00		0.00				10.00				10.00			0.33	0.27		0.33	0.27	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	100	0	1	04	01	H6609_100_0	5	Generic	3	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	100	0	1	04	01	H6609_100_0	5	Preferred Brand	3	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	100	0	1	04	01	H6609_100_0	5	Non-Preferred Drug	3	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	100	0	1	04	01	H6609_100_0	5	Specialty Tier	3	010010	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	102	0	1	04	01	H6609_102_0	5	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					9.00		27.00											10.00		30.00				9.00		0.00				10.00				10.00			0.33	0.30		0.33	0.30	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	102	0	1	04	01	H6609_102_0	5	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					9.00		27.00											10.00		30.00				9.00		0.00				10.00				10.00			0.33	0.30		0.33	0.30	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	102	0	1	04	01	H6609_102_0	5	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	102	0	1	04	01	H6609_102_0	5	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	102	0	1	04	01	H6609_102_0	5	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	102	0	1	04	01	H6609_102_0	5	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	102	0	1	04	01	H6609_102_0	5	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	102	0	1	04	01	H6609_102_0	5	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	102	0	1	04	01	H6609_102_0	5	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	102	0	1	04	01	H6609_102_0	5	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	103	0	1	04	01	H6609_103_0	5	Preferred Generic	3	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					9.00		27.00											10.00		30.00				9.00		0.00				10.00				10.00			0.33	0.30		0.33	0.30	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	103	0	1	04	01	H6609_103_0	5	Generic	3	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	103	0	1	04	01	H6609_103_0	5	Preferred Brand	3	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	103	0	1	04	01	H6609_103_0	5	Non-Preferred Drug	3	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	103	0	1	04	01	H6609_103_0	5	Specialty Tier	3	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	104	0	1	04	01	H6609_104_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	104	0	1	04	01	H6609_104_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	104	0	1	04	01	H6609_104_0	3	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	104	0	1	04	01	H6609_104_0	3	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	104	0	1	04	01	H6609_104_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	104	0	1	04	01	H6609_104_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	104	0	1	04	01	H6609_104_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	104	0	1	04	01	H6609_104_0	3	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	104	0	1	04	01	H6609_104_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	104	0	1	04	01	H6609_104_0	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	105	0	1	04	01	H6609_105_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	105	0	1	04	01	H6609_105_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	105	0	1	04	01	H6609_105_0	3	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	105	0	1	04	01	H6609_105_0	3	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	105	0	1	04	01	H6609_105_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	105	0	1	04	01	H6609_105_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	105	0	1	04	01	H6609_105_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	105	0	1	04	01	H6609_105_0	3	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	105	0	1	04	01	H6609_105_0	3	Specialty Tier	4	010010	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												
H6609	105	0	1	04	01	H6609_105_0	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	106	0	1	04	01	H6609_106_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	106	0	1	04	01	H6609_106_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	106	0	1	04	01	H6609_106_0	3	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	106	0	1	04	01	H6609_106_0	3	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	106	0	1	04	01	H6609_106_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	106	0	1	04	01	H6609_106_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	106	0	1	04	01	H6609_106_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	106	0	1	04	01	H6609_106_0	3	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	106	0	1	04	01	H6609_106_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	106	0	1	04	01	H6609_106_0	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	108	0	1	04	01	H6609_108_0	5	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	108	0	1	04	01	H6609_108_0	5	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	108	0	1	04	01	H6609_108_0	5	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								17.00		51.00					12.00		36.00											17.00		51.00				12.00		0.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	108	0	1	04	01	H6609_108_0	5	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								17.00		51.00					12.00		36.00											17.00		51.00				12.00		0.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	108	0	1	04	01	H6609_108_0	5	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	108	0	1	04	01	H6609_108_0	5	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	108	0	1	04	01	H6609_108_0	5	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	108	0	1	04	01	H6609_108_0	5	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	108	0	1	04	01	H6609_108_0	5	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	108	0	1	04	01	H6609_108_0	5	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	112	0	1	04	01	H6609_112_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	112	0	1	04	01	H6609_112_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	112	0	1	04	01	H6609_112_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								15.00		45.00					10.00		30.00											15.00		45.00				10.00		0.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	112	0	1	04	01	H6609_112_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								15.00		45.00					10.00		30.00											15.00		45.00				10.00		0.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	112	0	1	04	01	H6609_112_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	112	0	1	04	01	H6609_112_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	112	0	1	04	01	H6609_112_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	112	0	1	04	01	H6609_112_0	4	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	112	0	1	04	01	H6609_112_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	112	0	1	04	01	H6609_112_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	115	0	1	04	01	H6609_115_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	115	0	1	04	01	H6609_115_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	115	0	1	04	01	H6609_115_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								15.00		45.00					10.00		30.00											15.00		45.00				10.00		0.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	115	0	1	04	01	H6609_115_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								15.00		45.00					10.00		30.00											15.00		45.00				10.00		0.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	115	0	1	04	01	H6609_115_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	115	0	1	04	01	H6609_115_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	115	0	1	04	01	H6609_115_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	115	0	1	04	01	H6609_115_0	4	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	115	0	1	04	01	H6609_115_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	115	0	1	04	01	H6609_115_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	116	0	1	04	01	H6609_116_0	7	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	116	0	1	04	01	H6609_116_0	7	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	116	0	1	04	01	H6609_116_0	7	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	116	0	1	04	01	H6609_116_0	7	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	116	0	1	04	01	H6609_116_0	7	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	116	0	1	04	01	H6609_116_0	7	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	116	0	1	04	01	H6609_116_0	7	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	116	0	1	04	01	H6609_116_0	7	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	116	0	1	04	01	H6609_116_0	7	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	116	0	1	04	01	H6609_116_0	7	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	117	0	1	04	01	H6609_117_0	5	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	117	0	1	04	01	H6609_117_0	5	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	117	0	1	04	01	H6609_117_0	5	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	117	0	1	04	01	H6609_117_0	5	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	117	0	1	04	01	H6609_117_0	5	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	117	0	1	04	01	H6609_117_0	5	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	117	0	1	04	01	H6609_117_0	5	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	117	0	1	04	01	H6609_117_0	5	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	117	0	1	04	01	H6609_117_0	5	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	117	0	1	04	01	H6609_117_0	5	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	118	0	1	04	01	H6609_118_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	118	0	1	04	01	H6609_118_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	118	0	1	04	01	H6609_118_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	118	0	1	04	01	H6609_118_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	118	0	1	04	01	H6609_118_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	118	0	1	04	01	H6609_118_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	118	0	1	04	01	H6609_118_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	118	0	1	04	01	H6609_118_0	4	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	118	0	1	04	01	H6609_118_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	118	0	1	04	01	H6609_118_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	119	0	1	04	01	H6609_119_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	119	0	1	04	01	H6609_119_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	119	0	1	04	01	H6609_119_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	119	0	1	04	01	H6609_119_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	119	0	1	04	01	H6609_119_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	119	0	1	04	01	H6609_119_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	119	0	1	04	01	H6609_119_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	119	0	1	04	01	H6609_119_0	4	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	119	0	1	04	01	H6609_119_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	119	0	1	04	01	H6609_119_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	120	0	1	04	01	H6609_120_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	120	0	1	04	01	H6609_120_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	120	0	1	04	01	H6609_120_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	120	0	1	04	01	H6609_120_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	120	0	1	04	01	H6609_120_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	120	0	1	04	01	H6609_120_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	120	0	1	04	01	H6609_120_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	120	0	1	04	01	H6609_120_0	4	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	120	0	1	04	01	H6609_120_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	120	0	1	04	01	H6609_120_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	121	0	1	04	01	H6609_121_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	121	0	1	04	01	H6609_121_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	121	0	1	04	01	H6609_121_0	4	Generic	4	010001	3	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								17.00		51.00					12.00		36.00											17.00		51.00				12.00		0.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	121	0	1	04	01	H6609_121_0	4	Generic	4	010001	3	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								17.00		51.00					12.00		36.00											17.00		51.00				12.00		0.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	3
H6609	121	0	1	04	01	H6609_121_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	121	0	1	04	01	H6609_121_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	121	0	1	04	01	H6609_121_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	121	0	1	04	01	H6609_121_0	4	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	121	0	1	04	01	H6609_121_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	121	0	1	04	01	H6609_121_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	122	0	1	04	01	H6609_122_0	3	Preferred Generic	3	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	122	0	1	04	01	H6609_122_0	3	Generic	3	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	122	0	1	04	01	H6609_122_0	3	Preferred Brand	3	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	122	0	1	04	01	H6609_122_0	3	Non-Preferred Drug	3	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	122	0	1	04	01	H6609_122_0	3	Specialty Tier	3	010010	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												
H6609	123	0	1	04	01	H6609_123_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					8.00		24.00											10.00		30.00				8.00		0.00				10.00				10.00			0.33	0.27		0.33	0.27	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	123	0	1	04	01	H6609_123_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					8.00		24.00											10.00		30.00				8.00		0.00				10.00				10.00			0.33	0.27		0.33	0.27	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	123	0	1	04	01	H6609_123_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	123	0	1	04	01	H6609_123_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	123	0	1	04	01	H6609_123_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	123	0	1	04	01	H6609_123_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	123	0	1	04	01	H6609_123_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	123	0	1	04	01	H6609_123_0	4	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	123	0	1	04	01	H6609_123_0	4	Specialty Tier	4	010010	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												
H6609	123	0	1	04	01	H6609_123_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	124	0	1	04	01	H6609_124_0	4	Preferred Generic	3	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	124	0	1	04	01	H6609_124_0	4	Generic	3	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	124	0	1	04	01	H6609_124_0	4	Preferred Brand	3	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	124	0	1	04	01	H6609_124_0	4	Non-Preferred Drug	3	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	124	0	1	04	01	H6609_124_0	4	Specialty Tier	3	010010	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												
H6609	126	0	1	04	01	H6609_126_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					8.00		24.00											10.00		30.00				8.00		0.00				10.00				10.00			0.33	0.27		0.33	0.27	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	126	0	1	04	01	H6609_126_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					8.00		24.00											10.00		30.00				8.00		0.00				10.00				10.00			0.33	0.27		0.33	0.27	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	126	0	1	04	01	H6609_126_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	126	0	1	04	01	H6609_126_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	126	0	1	04	01	H6609_126_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	126	0	1	04	01	H6609_126_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	126	0	1	04	01	H6609_126_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	126	0	1	04	01	H6609_126_0	4	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	126	0	1	04	01	H6609_126_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	126	0	1	04	01	H6609_126_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	127	0	1	04	01	H6609_127_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	127	0	1	04	01	H6609_127_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	127	0	1	04	01	H6609_127_0	3	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	127	0	1	04	01	H6609_127_0	3	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	127	0	1	04	01	H6609_127_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	127	0	1	04	01	H6609_127_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	127	0	1	04	01	H6609_127_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	127	0	1	04	01	H6609_127_0	3	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	127	0	1	04	01	H6609_127_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	127	0	1	04	01	H6609_127_0	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	128	0	1	04	01	H6609_128_0	3	Preferred Generic	3	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								9.00		27.00					4.00		12.00											9.00		27.00				4.00		0.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	128	0	1	04	01	H6609_128_0	3	Generic	3	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								19.00		57.00					14.00		42.00											19.00		57.00				14.00		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												
H6609	128	0	1	04	01	H6609_128_0	3	Preferred Brand	3	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	128	0	1	04	01	H6609_128_0	3	Non-Preferred Drug	3	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	128	0	1	04	01	H6609_128_0	3	Specialty Tier	3	010010	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												
H6609	129	0	1	04	01	H6609_129_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								9.00		27.00					4.00		12.00											9.00		27.00				4.00		0.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	129	0	1	04	01	H6609_129_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								9.00		27.00					4.00		12.00											9.00		27.00				4.00		0.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	129	0	1	04	01	H6609_129_0	3	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	129	0	1	04	01	H6609_129_0	3	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	129	0	1	04	01	H6609_129_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	129	0	1	04	01	H6609_129_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	129	0	1	04	01	H6609_129_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	129	0	1	04	01	H6609_129_0	3	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	129	0	1	04	01	H6609_129_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	129	0	1	04	01	H6609_129_0	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	130	0	1	04	01	H6609_130_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	130	0	1	04	01	H6609_130_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	130	0	1	04	01	H6609_130_0	3	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	130	0	1	04	01	H6609_130_0	3	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	130	0	1	04	01	H6609_130_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	130	0	1	04	01	H6609_130_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	130	0	1	04	01	H6609_130_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	130	0	1	04	01	H6609_130_0	3	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	130	0	1	04	01	H6609_130_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	130	0	1	04	01	H6609_130_0	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	131	0	1	04	01	H6609_131_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								9.00		27.00					4.00		12.00											9.00		27.00				4.00		0.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	131	0	1	04	01	H6609_131_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								9.00		27.00					4.00		12.00											9.00		27.00				4.00		0.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	131	0	1	04	01	H6609_131_0	3	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								14.00		42.00					9.00		27.00											14.00		42.00				9.00		0.00				14.00				14.00			0.47	0.30		0.47	0.30	0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	131	0	1	04	01	H6609_131_0	3	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								14.00		42.00					9.00		27.00											14.00		42.00				9.00		0.00				14.00				14.00			0.47	0.30		0.47	0.30	0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	131	0	1	04	01	H6609_131_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	131	0	1	04	01	H6609_131_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	131	0	1	04	01	H6609_131_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	131	0	1	04	01	H6609_131_0	3	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	131	0	1	04	01	H6609_131_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	131	0	1	04	01	H6609_131_0	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	132	0	1	04	01	H6609_132_0	3	Preferred Generic	3	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	132	0	1	04	01	H6609_132_0	3	Generic	3	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								19.00		57.00					14.00		42.00											19.00		57.00				14.00		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												
H6609	132	0	1	04	01	H6609_132_0	3	Preferred Brand	3	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	132	0	1	04	01	H6609_132_0	3	Non-Preferred Drug	3	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	132	0	1	04	01	H6609_132_0	3	Specialty Tier	3	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	133	0	1	04	01	H6609_133_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	133	0	1	04	01	H6609_133_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	133	0	1	04	01	H6609_133_0	3	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	133	0	1	04	01	H6609_133_0	3	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	133	0	1	04	01	H6609_133_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	133	0	1	04	01	H6609_133_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	133	0	1	04	01	H6609_133_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	133	0	1	04	01	H6609_133_0	3	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	133	0	1	04	01	H6609_133_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	133	0	1	04	01	H6609_133_0	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	135	0	1	04	01	H6609_135_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	135	0	1	04	01	H6609_135_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	135	0	1	04	01	H6609_135_0	3	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	135	0	1	04	01	H6609_135_0	3	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	135	0	1	04	01	H6609_135_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	135	0	1	04	01	H6609_135_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	135	0	1	04	01	H6609_135_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	135	0	1	04	01	H6609_135_0	3	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	135	0	1	04	01	H6609_135_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	135	0	1	04	01	H6609_135_0	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	137	0	1	04	01	H6609_137_0	7	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	137	0	1	04	01	H6609_137_0	7	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	137	0	1	04	01	H6609_137_0	7	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	137	0	1	04	01	H6609_137_0	7	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	137	0	1	04	01	H6609_137_0	7	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	137	0	1	04	01	H6609_137_0	7	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	137	0	1	04	01	H6609_137_0	7	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	137	0	1	04	01	H6609_137_0	7	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	137	0	1	04	01	H6609_137_0	7	Specialty Tier	4	010010	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												
H6609	137	0	1	04	01	H6609_137_0	7	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												30							30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	138	0	1	04	01	H6609_138_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	138	0	1	04	01	H6609_138_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	138	0	1	04	01	H6609_138_0	3	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					18.00		54.00											20.00		60.00				18.00		0.00				20.00				20.00			0.67	0.60		0.67	0.60	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	138	0	1	04	01	H6609_138_0	3	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					18.00		54.00											20.00		60.00				18.00		0.00				20.00				20.00			0.67	0.60		0.67	0.60	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	138	0	1	04	01	H6609_138_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	138	0	1	04	01	H6609_138_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	138	0	1	04	01	H6609_138_0	3	Non-Preferred Drug	4	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											88.00	50		50				87.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	138	0	1	04	01	H6609_138_0	3	Non-Preferred Drug	4	110000	1	1	4	3		110	01		110	1				30		90	2	2				30		90	30		31											79.00	31		31				79.00	31		31										31		31				31		31			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	138	0	1	04	01	H6609_138_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	138	0	1	04	01	H6609_138_0	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	140	0	1	04	01	H6609_140_0	5	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	140	0	1	04	01	H6609_140_0	5	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	140	0	1	04	01	H6609_140_0	5	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					18.00		54.00											20.00		60.00				18.00		0.00				20.00				20.00			0.67	0.60		0.67	0.60	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	140	0	1	04	01	H6609_140_0	5	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					18.00		54.00											20.00		60.00				18.00		0.00				20.00				20.00			0.67	0.60		0.67	0.60	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	140	0	1	04	01	H6609_140_0	5	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	140	0	1	04	01	H6609_140_0	5	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	140	0	1	04	01	H6609_140_0	5	Non-Preferred Drug	4	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											83.00	50		50				82.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	140	0	1	04	01	H6609_140_0	5	Non-Preferred Drug	4	110000	1	1	4	3		110	01		110	1				30		90	2	2				30		90	30		31											82.00	31		31				81.00	31		31										31		31				31		31			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	140	0	1	04	01	H6609_140_0	5	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	140	0	1	04	01	H6609_140_0	5	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	143	0	1	04	01	H6609_143_0	5	Preferred Generic	4	001010	1	2	1	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												
H6609	143	0	1	04	01	H6609_143_0	5	Preferred Generic	4	001010	1	2	1	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										2	3	
H6609	143	0	1	04	01	H6609_143_0	5	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	143	0	1	04	01	H6609_143_0	5	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	143	0	1	04	01	H6609_143_0	5	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	143	0	1	04	01	H6609_143_0	5	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	143	0	1	04	01	H6609_143_0	5	Non-Preferred Drug	4	110000	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												
H6609	143	0	1	04	01	H6609_143_0	5	Non-Preferred Drug	4	110000	1	1	4	3		110	01		110	1				30		90	2	2				30		90	30		31											83.00	31		31				83.00	31		31										31		31				31		31			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	143	0	1	04	01	H6609_143_0	5	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	143	0	1	04	01	H6609_143_0	5	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	144	1	1	04	01	H6609_144_1	5	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	144	1	1	04	01	H6609_144_1	5	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	144	1	1	04	01	H6609_144_1	5	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	144	1	1	04	01	H6609_144_1	5	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	144	1	1	04	01	H6609_144_1	5	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	144	1	1	04	01	H6609_144_1	5	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	144	1	1	04	01	H6609_144_1	5	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	144	1	1	04	01	H6609_144_1	5	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	144	1	1	04	01	H6609_144_1	5	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	144	1	1	04	01	H6609_144_1	5	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	144	2	1	04	01	H6609_144_2	5	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	144	2	1	04	01	H6609_144_2	5	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	144	2	1	04	01	H6609_144_2	5	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	144	2	1	04	01	H6609_144_2	5	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	144	2	1	04	01	H6609_144_2	5	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	144	2	1	04	01	H6609_144_2	5	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	144	2	1	04	01	H6609_144_2	5	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	144	2	1	04	01	H6609_144_2	5	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	144	2	1	04	01	H6609_144_2	5	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	144	2	1	04	01	H6609_144_2	5	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	147	1	1	04	01	H6609_147_1	3	Preferred Generic	4	001010	1	2	1	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												
H6609	147	1	1	04	01	H6609_147_1	3	Preferred Generic	4	001010	1	2	1	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										2	3	
H6609	147	1	1	04	01	H6609_147_1	3	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	147	1	1	04	01	H6609_147_1	3	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	147	1	1	04	01	H6609_147_1	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	147	1	1	04	01	H6609_147_1	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	147	1	1	04	01	H6609_147_1	3	Non-Preferred Drug	4	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											81.00	50		50				80.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	147	1	1	04	01	H6609_147_1	3	Non-Preferred Drug	4	110000	1	1	4	3		110	01		110	1				30		90	2	2				30		90	30		31											76.00	31		31				76.00	31		31										31		31				31		31			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	147	1	1	04	01	H6609_147_1	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	147	1	1	04	01	H6609_147_1	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	147	2	1	04	01	H6609_147_2	3	Preferred Generic	4	001010	1	2	1	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												
H6609	147	2	1	04	01	H6609_147_2	3	Preferred Generic	4	001010	1	2	1	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										2	3	
H6609	147	2	1	04	01	H6609_147_2	3	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	147	2	1	04	01	H6609_147_2	3	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	147	2	1	04	01	H6609_147_2	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	147	2	1	04	01	H6609_147_2	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	147	2	1	04	01	H6609_147_2	3	Non-Preferred Drug	4	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											81.00	50		50				80.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	147	2	1	04	01	H6609_147_2	3	Non-Preferred Drug	4	110000	1	1	4	3		110	01		110	1				30		90	2	2				30		90	30		31											76.00	31		31				76.00	31		31										31		31				31		31			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	147	2	1	04	01	H6609_147_2	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	147	2	1	04	01	H6609_147_2	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	147	3	1	04	01	H6609_147_3	5	Preferred Generic	4	001010	1	2	1	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												
H6609	147	3	1	04	01	H6609_147_3	5	Preferred Generic	4	001010	1	2	1	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										2	3	
H6609	147	3	1	04	01	H6609_147_3	5	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	147	3	1	04	01	H6609_147_3	5	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	147	3	1	04	01	H6609_147_3	5	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	147	3	1	04	01	H6609_147_3	5	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	147	3	1	04	01	H6609_147_3	5	Non-Preferred Drug	4	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											81.00	50		50				80.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	147	3	1	04	01	H6609_147_3	5	Non-Preferred Drug	4	110000	1	1	4	3		110	01		110	1				30		90	2	2				30		90	30		31											76.00	31		31				76.00	31		31										31		31				31		31			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	147	3	1	04	01	H6609_147_3	5	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	147	3	1	04	01	H6609_147_3	5	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	148	1	1	04	01	H6609_148_1	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	148	1	1	04	01	H6609_148_1	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	148	1	1	04	01	H6609_148_1	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	148	1	1	04	01	H6609_148_1	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	148	1	1	04	01	H6609_148_1	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	148	1	1	04	01	H6609_148_1	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	148	1	1	04	01	H6609_148_1	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	148	1	1	04	01	H6609_148_1	4	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	148	1	1	04	01	H6609_148_1	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	148	1	1	04	01	H6609_148_1	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	148	2	1	04	01	H6609_148_2	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	148	2	1	04	01	H6609_148_2	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	148	2	1	04	01	H6609_148_2	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	148	2	1	04	01	H6609_148_2	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	148	2	1	04	01	H6609_148_2	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	148	2	1	04	01	H6609_148_2	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	148	2	1	04	01	H6609_148_2	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	148	2	1	04	01	H6609_148_2	4	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	148	2	1	04	01	H6609_148_2	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	148	2	1	04	01	H6609_148_2	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	149	1	1	04	01	H6609_149_1	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	149	1	1	04	01	H6609_149_1	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	149	1	1	04	01	H6609_149_1	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	149	1	1	04	01	H6609_149_1	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	149	1	1	04	01	H6609_149_1	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	149	1	1	04	01	H6609_149_1	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	149	1	1	04	01	H6609_149_1	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	149	1	1	04	01	H6609_149_1	4	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	149	1	1	04	01	H6609_149_1	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	149	1	1	04	01	H6609_149_1	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	149	2	1	04	01	H6609_149_2	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	149	2	1	04	01	H6609_149_2	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	149	2	1	04	01	H6609_149_2	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	149	2	1	04	01	H6609_149_2	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	149	2	1	04	01	H6609_149_2	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	149	2	1	04	01	H6609_149_2	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	149	2	1	04	01	H6609_149_2	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	149	2	1	04	01	H6609_149_2	4	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	149	2	1	04	01	H6609_149_2	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	149	2	1	04	01	H6609_149_2	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	150	0	1	04	01	H6609_150_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								7.00		21.00					2.00		6.00											7.00		21.00				2.00		0.00				7.00				7.00			0.23	0.07		0.23	0.07	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	150	0	1	04	01	H6609_150_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								7.00		21.00					2.00		6.00											7.00		21.00				2.00		0.00				7.00				7.00			0.23	0.07		0.23	0.07	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	150	0	1	04	01	H6609_150_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								15.00		45.00					10.00		30.00											15.00		45.00				10.00		0.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	150	0	1	04	01	H6609_150_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								15.00		45.00					10.00		30.00											15.00		45.00				10.00		0.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	150	0	1	04	01	H6609_150_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	150	0	1	04	01	H6609_150_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	150	0	1	04	01	H6609_150_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	150	0	1	04	01	H6609_150_0	4	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	150	0	1	04	01	H6609_150_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	150	0	1	04	01	H6609_150_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	151	0	1	04	01	H6609_151_0	5	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	151	0	1	04	01	H6609_151_0	5	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	151	0	1	04	01	H6609_151_0	5	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								18.00		54.00					13.00		39.00											18.00		54.00				13.00		0.00				18.00				18.00			0.60	0.43		0.60	0.43	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	151	0	1	04	01	H6609_151_0	5	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								18.00		54.00					13.00		39.00											18.00		54.00				13.00		0.00				18.00				18.00			0.60	0.43		0.60	0.43	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	151	0	1	04	01	H6609_151_0	5	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	151	0	1	04	01	H6609_151_0	5	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	151	0	1	04	01	H6609_151_0	5	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	151	0	1	04	01	H6609_151_0	5	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	151	0	1	04	01	H6609_151_0	5	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	151	0	1	04	01	H6609_151_0	5	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	152	1	1	04	01	H6609_152_1	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	152	1	1	04	01	H6609_152_1	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	152	1	1	04	01	H6609_152_1	3	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	152	1	1	04	01	H6609_152_1	3	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	152	1	1	04	01	H6609_152_1	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	152	1	1	04	01	H6609_152_1	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	152	1	1	04	01	H6609_152_1	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	152	1	1	04	01	H6609_152_1	3	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	152	1	1	04	01	H6609_152_1	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	152	1	1	04	01	H6609_152_1	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	152	2	1	04	01	H6609_152_2	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	152	2	1	04	01	H6609_152_2	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	152	2	1	04	01	H6609_152_2	3	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	152	2	1	04	01	H6609_152_2	3	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	152	2	1	04	01	H6609_152_2	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	152	2	1	04	01	H6609_152_2	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	152	2	1	04	01	H6609_152_2	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	152	2	1	04	01	H6609_152_2	3	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6609	152	2	1	04	01	H6609_152_2	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6609	152	2	1	04	01	H6609_152_2	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	001	0	1	01	01	H6622_001_0	5	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	001	0	1	01	01	H6622_001_0	5	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	001	0	1	01	01	H6622_001_0	5	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	001	0	1	01	01	H6622_001_0	5	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	001	0	1	01	01	H6622_001_0	5	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	001	0	1	01	01	H6622_001_0	5	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	001	0	1	01	01	H6622_001_0	5	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	001	0	1	01	01	H6622_001_0	5	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	001	0	1	01	01	H6622_001_0	5	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	001	0	1	01	01	H6622_001_0	5	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	002	0	1	01	01	H6622_002_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	002	0	1	01	01	H6622_002_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	002	0	1	01	01	H6622_002_0	3	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	002	0	1	01	01	H6622_002_0	3	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	002	0	1	01	01	H6622_002_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	002	0	1	01	01	H6622_002_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	002	0	1	01	01	H6622_002_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	002	0	1	01	01	H6622_002_0	3	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	002	0	1	01	01	H6622_002_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	002	0	1	01	01	H6622_002_0	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	004	0	1	01	01	H6622_004_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	004	0	1	01	01	H6622_004_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	004	0	1	01	01	H6622_004_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	004	0	1	01	01	H6622_004_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	004	0	1	01	01	H6622_004_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	004	0	1	01	01	H6622_004_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	004	0	1	01	01	H6622_004_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	004	0	1	01	01	H6622_004_0	4	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	004	0	1	01	01	H6622_004_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	004	0	1	01	01	H6622_004_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	005	0	1	01	01	H6622_005_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	005	0	1	01	01	H6622_005_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	005	0	1	01	01	H6622_005_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	005	0	1	01	01	H6622_005_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	005	0	1	01	01	H6622_005_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	005	0	1	01	01	H6622_005_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	005	0	1	01	01	H6622_005_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	005	0	1	01	01	H6622_005_0	4	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	005	0	1	01	01	H6622_005_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	005	0	1	01	01	H6622_005_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	007	0	1	01	01	H6622_007_0	5	Preferred Generic	4	001010	1	2	1	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												
H6622	007	0	1	01	01	H6622_007_0	5	Preferred Generic	4	001010	1	2	1	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										2	3	
H6622	007	0	1	01	01	H6622_007_0	5	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	007	0	1	01	01	H6622_007_0	5	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	007	0	1	01	01	H6622_007_0	5	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	007	0	1	01	01	H6622_007_0	5	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	007	0	1	01	01	H6622_007_0	5	Non-Preferred Drug	4	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											84.00	50		50				83.00	50		50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	007	0	1	01	01	H6622_007_0	5	Non-Preferred Drug	4	110000	1	1	4	3		110	01		110	1				30		90	2	2				30		90	30		31											82.00	31		31				81.00	31		31										31		31				31		31			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	007	0	1	01	01	H6622_007_0	5	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	007	0	1	01	01	H6622_007_0	5	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	008	0	1	01	01	H6622_008_0	5	Preferred Generic	3	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	008	0	1	01	01	H6622_008_0	5	Generic	3	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								8.00		24.00					3.00		9.00											8.00		24.00				3.00		0.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	008	0	1	01	01	H6622_008_0	5	Preferred Brand	3	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	008	0	1	01	01	H6622_008_0	5	Non-Preferred Drug	3	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	008	0	1	01	01	H6622_008_0	5	Specialty Tier	3	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	010	0	1	01	01	H6622_010_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	010	0	1	01	01	H6622_010_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	010	0	1	01	01	H6622_010_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								17.00		51.00					12.00		36.00											17.00		51.00				12.00		0.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	010	0	1	01	01	H6622_010_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								17.00		51.00					12.00		36.00											17.00		51.00				12.00		0.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	010	0	1	01	01	H6622_010_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	010	0	1	01	01	H6622_010_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	010	0	1	01	01	H6622_010_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	010	0	1	01	01	H6622_010_0	4	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	010	0	1	01	01	H6622_010_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	010	0	1	01	01	H6622_010_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	011	0	1	01	01	H6622_011_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	011	0	1	01	01	H6622_011_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	011	0	1	01	01	H6622_011_0	3	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	011	0	1	01	01	H6622_011_0	3	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	011	0	1	01	01	H6622_011_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	011	0	1	01	01	H6622_011_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	011	0	1	01	01	H6622_011_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	011	0	1	01	01	H6622_011_0	3	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	011	0	1	01	01	H6622_011_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	011	0	1	01	01	H6622_011_0	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	012	0	1	01	01	H6622_012_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	012	0	1	01	01	H6622_012_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	012	0	1	01	01	H6622_012_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	012	0	1	01	01	H6622_012_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	012	0	1	01	01	H6622_012_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	012	0	1	01	01	H6622_012_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	012	0	1	01	01	H6622_012_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	012	0	1	01	01	H6622_012_0	4	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	012	0	1	01	01	H6622_012_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	012	0	1	01	01	H6622_012_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	013	0	1	01	01	H6622_013_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	013	0	1	01	01	H6622_013_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	013	0	1	01	01	H6622_013_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	013	0	1	01	01	H6622_013_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	013	0	1	01	01	H6622_013_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	013	0	1	01	01	H6622_013_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	013	0	1	01	01	H6622_013_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	013	0	1	01	01	H6622_013_0	4	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	013	0	1	01	01	H6622_013_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	013	0	1	01	01	H6622_013_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	014	0	1	01	01	H6622_014_0	5	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	014	0	1	01	01	H6622_014_0	5	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	014	0	1	01	01	H6622_014_0	5	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	014	0	1	01	01	H6622_014_0	5	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	014	0	1	01	01	H6622_014_0	5	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	014	0	1	01	01	H6622_014_0	5	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	014	0	1	01	01	H6622_014_0	5	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	014	0	1	01	01	H6622_014_0	5	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	014	0	1	01	01	H6622_014_0	5	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	014	0	1	01	01	H6622_014_0	5	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	015	0	1	01	01	H6622_015_0	4	Preferred Generic	3	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	015	0	1	01	01	H6622_015_0	4	Generic	3	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					13.00		39.00											20.00		60.00				13.00		0.00				20.00				20.00			0.67	0.43		0.67	0.43	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	015	0	1	01	01	H6622_015_0	4	Preferred Brand	3	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	015	0	1	01	01	H6622_015_0	4	Non-Preferred Drug	3	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	015	0	1	01	01	H6622_015_0	4	Specialty Tier	3	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	016	0	1	01	01	H6622_016_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	016	0	1	01	01	H6622_016_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	016	0	1	01	01	H6622_016_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	016	0	1	01	01	H6622_016_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	016	0	1	01	01	H6622_016_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	016	0	1	01	01	H6622_016_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	016	0	1	01	01	H6622_016_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	016	0	1	01	01	H6622_016_0	4	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	016	0	1	01	01	H6622_016_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	016	0	1	01	01	H6622_016_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	017	0	1	01	01	H6622_017_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6622	017	0	1	01	01	H6622_017_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H6622	017	0	1	01	01	H6622_017_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6622	017	0	1	01	01	H6622_017_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H6622	017	0	1	01	01	H6622_017_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6622	017	0	1	01	01	H6622_017_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	3	
H6622	017	0	1	01	01	H6622_017_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6622	017	0	1	01	01	H6622_017_0	4	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				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										2	3	
H6622	017	0	1	01	01	H6622_017_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6622	017	0	1	01	01	H6622_017_0	4	Specialty Tier	4	010010	1	1	5	3		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										2	3	
H6622	017	0	1	01	01	H6622_017_0	4	Select Care Drugs	4	010010	1	2	6	1		110	01		110	1				30		90	2	2				30		90	30		31								11.00		33.00					7.00		21.00											11.00		33.00				7.00		0.00				11.00				11.00			0.37	0.23		0.37	0.23	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6622	018	0	1	01	01	H6622_018_0	3	Preferred Generic	3	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								0.00		0.00					0.00		0.00											0.00		0.00				0.00		0.00				0.00				0.00			0	0		0	0	0	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	018	0	1	01	01	H6622_018_0	3	Generic	3	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								7.00		21.00					2.00		6.00											7.00		21.00				2.00		0.00				7.00				7.00			0.23	0.07		0.23	0.07	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	018	0	1	01	01	H6622_018_0	3	Preferred Brand	3	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	018	0	1	01	01	H6622_018_0	3	Non-Preferred Drug	3	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	018	0	1	01	01	H6622_018_0	3	Specialty Tier	3	010010	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	019	0	1	01	01	H6622_019_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								6.00		18.00					1.00		3.00											6.00		18.00				1.00		0.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	019	0	1	01	01	H6622_019_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								6.00		18.00					1.00		3.00											6.00		18.00				1.00		0.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	019	0	1	01	01	H6622_019_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								9.00		27.00					4.00		12.00											9.00		27.00				4.00		0.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	019	0	1	01	01	H6622_019_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								9.00		27.00					4.00		12.00											9.00		27.00				4.00		0.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	019	0	1	01	01	H6622_019_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	019	0	1	01	01	H6622_019_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	019	0	1	01	01	H6622_019_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	019	0	1	01	01	H6622_019_0	4	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	019	0	1	01	01	H6622_019_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	019	0	1	01	01	H6622_019_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	020	0	1	01	01	H6622_020_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								6.00		18.00					1.00		3.00											6.00		18.00				1.00		0.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	020	0	1	01	01	H6622_020_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								6.00		18.00					1.00		3.00											6.00		18.00				1.00		0.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	020	0	1	01	01	H6622_020_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								9.00		27.00					4.00		12.00											9.00		27.00				4.00		0.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	020	0	1	01	01	H6622_020_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								9.00		27.00					4.00		12.00											9.00		27.00				4.00		0.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	020	0	1	01	01	H6622_020_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	020	0	1	01	01	H6622_020_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	020	0	1	01	01	H6622_020_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	020	0	1	01	01	H6622_020_0	4	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	020	0	1	01	01	H6622_020_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	020	0	1	01	01	H6622_020_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	021	1	1	01	01	H6622_021_1	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	021	1	1	01	01	H6622_021_1	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	021	1	1	01	01	H6622_021_1	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	021	1	1	01	01	H6622_021_1	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	021	1	1	01	01	H6622_021_1	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	021	1	1	01	01	H6622_021_1	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	021	1	1	01	01	H6622_021_1	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	021	1	1	01	01	H6622_021_1	4	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	021	1	1	01	01	H6622_021_1	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	021	1	1	01	01	H6622_021_1	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	021	2	1	01	01	H6622_021_2	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	021	2	1	01	01	H6622_021_2	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	021	2	1	01	01	H6622_021_2	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	021	2	1	01	01	H6622_021_2	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	021	2	1	01	01	H6622_021_2	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	021	2	1	01	01	H6622_021_2	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	021	2	1	01	01	H6622_021_2	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	021	2	1	01	01	H6622_021_2	4	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	021	2	1	01	01	H6622_021_2	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	021	2	1	01	01	H6622_021_2	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	022	0	1	01	01	H6622_022_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	022	0	1	01	01	H6622_022_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	022	0	1	01	01	H6622_022_0	3	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	022	0	1	01	01	H6622_022_0	3	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	022	0	1	01	01	H6622_022_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	022	0	1	01	01	H6622_022_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	022	0	1	01	01	H6622_022_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	022	0	1	01	01	H6622_022_0	3	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6622	022	0	1	01	01	H6622_022_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6622	022	0	1	01	01	H6622_022_0	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6672	003	0	1	01	01	H6672_003_0	10	Preferred Generic	4	001000	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	4.00	8.00	12.00																					8.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6672	003	0	1	01	01	H6672_003_0	10	Generic	4	010000	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	12.00	24.00	36.00																					24.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6672	003	0	1	01	01	H6672_003_0	10	Preferred Brand	4	000001	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					94.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6672	003	0	1	01	01	H6672_003_0	10	Non-Preferred Drug	4	100100	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					200.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6672	003	0	1	01	01	H6672_003_0	10	Specialty Tier	4	010010	1	1	5	1	111		01	100		1	30	60	90				1	2			90				30		31					28	28	28																				28															28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6672	003	0	1	01	01	H6672_003_0	10	Select Care Drugs	4	010010	1	2	6	1	111		01	100		1	30	60	90				1	2			90				30		31	11.00	22.00	33.00																					22.00																11.00				11.00		0.37						0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6672	004	0	1	01	01	H6672_004_0	9	Preferred Generic	4	001000	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	4.00	8.00	12.00																					8.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6672	004	0	1	01	01	H6672_004_0	9	Generic	4	010000	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	12.00	24.00	36.00																					24.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6672	004	0	1	01	01	H6672_004_0	9	Preferred Brand	4	000001	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												
H6672	004	0	1	01	01	H6672_004_0	9	Non-Preferred Brand	4	100100	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												
H6672	004	0	1	01	01	H6672_004_0	9	Specialty Tier	4	010010	1	1	5	1	111		01	100		1	30	60	90				1	2			90				30		31					28	28	28																				28															28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6723	001	1	1	01	01	H6723_001_1	10	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	8.00	10.00																			5.00	8.00	10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	001	1	1	01	01	H6723_001_1	10	Preferred Generic	4	001000	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	8.00	10.00																			5.00	8.00	10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6723	001	1	1	01	01	H6723_001_1	10	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	19.00	29.00	38.00																			19.00	29.00	38.00																19.00				19.00		0.63			0.63			0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	001	1	1	01	01	H6723_001_1	10	Generic	4	010000	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	19.00	29.00	38.00																			19.00	29.00	38.00																19.00				19.00		0.63			0.63			0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6723	001	1	1	01	01	H6723_001_1	10	Preferred Brand	4	000001	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 Drug, Specialty Tier												
H6723	001	1	1	01	01	H6723_001_1	10	Non-Preferred Drug	4	110000	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				61.82	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	10	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31					29																				29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	001	2	1	01	01	H6723_001_2	10	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	8.00	10.00																			5.00	8.00	10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	001	2	1	01	01	H6723_001_2	10	Preferred Generic	4	001000	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	8.00	10.00																			5.00	8.00	10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6723	001	2	1	01	01	H6723_001_2	10	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	19.00	29.00	38.00																			19.00	29.00	38.00																19.00				19.00		0.63			0.63			0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	001	2	1	01	01	H6723_001_2	10	Generic	4	010000	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	19.00	29.00	38.00																			19.00	29.00	38.00																19.00				19.00		0.63			0.63			0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6723	001	2	1	01	01	H6723_001_2	10	Preferred Brand	4	000001	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 Drug, Specialty Tier												
H6723	001	2	1	01	01	H6723_001_2	10	Non-Preferred Drug	4	110000	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				61.82	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	10	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31					29																				29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	002	1	1	01	01	H6723_002_1	8	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	002	1	1	01	01	H6723_002_1	8	Preferred Generic	4	001000	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		
H6723	002	1	1	01	01	H6723_002_1	8	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	14.00	21.00	28.00																			14.00	21.00	28.00																14.00				14.00		0.47			0.47			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	002	1	1	01	01	H6723_002_1	8	Generic	4	010000	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	14.00	21.00	28.00																			14.00	21.00	28.00																14.00				14.00		0.47			0.47			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6723	002	1	1	01	01	H6723_002_1	8	Preferred Brand	4	000001	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 Drug, Specialty Tier												
H6723	002	1	1	01	01	H6723_002_1	8	Non-Preferred Drug	4	110000	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				51.23	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	8	Specialty Tier	4	010010	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												
H6723	002	2	1	01	01	H6723_002_2	8	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	002	2	1	01	01	H6723_002_2	8	Preferred Generic	4	001000	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		
H6723	002	2	1	01	01	H6723_002_2	8	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	14.00	21.00	28.00																			14.00	21.00	28.00																14.00				14.00		0.47			0.47			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6723	002	2	1	01	01	H6723_002_2	8	Generic	4	010000	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	14.00	21.00	28.00																			14.00	21.00	28.00																14.00				14.00		0.47			0.47			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H6723	002	2	1	01	01	H6723_002_2	8	Preferred Brand	4	000001	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 Drug, Specialty Tier												
H6723	002	2	1	01	01	H6723_002_2	8	Non-Preferred Drug	4	110000	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				51.23	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	8	Specialty Tier	4	010010	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												
H6743	001	0	1	04	01	H6743_001_0	7	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	10.00		20.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6743	001	0	1	04	01	H6743_001_0	7	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	20.00		40.00																					40.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6743	001	0	1	04	01	H6743_001_0	7	Preferred Brand	4	000001	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 Brand, Specialty Tier, Select Care Drugs												
H6743	001	0	1	04	01	H6743_001_0	7	Non-Preferred Brand	4	100000	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 Brand, Specialty Tier, Select Care Drugs												
H6743	001	0	1	04	01	H6743_001_0	7	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31				829.07	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6743	001	0	1	04	01	H6743_001_0	7	Select Care Drugs	4	010010	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												
H6743	003	0	1	04	01	H6743_003_0	7	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	6.00		12.00																					12.00																6.00				6.00		0.20						0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6743	003	0	1	04	01	H6743_003_0	7	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	15.00		30.00																					30.00																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6743	003	0	1	04	01	H6743_003_0	7	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	40.00		80.00																					80.00																40.00				40.00		1.33						1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6743	003	0	1	04	01	H6743_003_0	7	Non-Preferred Brand	4	100000	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	85.00		170.00																					170.00																85.00				85.00		2.83						2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6743	003	0	1	04	01	H6743_003_0	7	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31				437.32	29																				29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6743	003	0	1	04	01	H6743_003_0	7	Select Care Drugs	4	010010	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												
H6743	004	0	1	04	01	H6743_004_0	7	Preferred Generic	4	001000	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 Brand, Specialty Tier, Select Care Drugs												
H6743	004	0	1	04	01	H6743_004_0	7	Generic	4	010000	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 Brand, Specialty Tier, Select Care Drugs												
H6743	004	0	1	04	01	H6743_004_0	7	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	35.00		70.00																					70.00																35.00				35.00		1.17						1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6743	004	0	1	04	01	H6743_004_0	7	Non-Preferred Brand	4	100000	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	75.00		150.00																					150.00																75.00				75.00		2.50						2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6743	004	0	1	04	01	H6743_004_0	7	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31				633.62	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6743	004	0	1	04	01	H6743_004_0	7	Select Care Drugs	4	010010	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												
H6743	007	0	1	04	01	H6743_007_0	7	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	10.00		20.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6743	007	0	1	04	01	H6743_007_0	7	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	20.00		40.00																					40.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6743	007	0	1	04	01	H6743_007_0	7	Preferred Brand	4	000001	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 Brand, Specialty Tier, Select Care Drugs												
H6743	007	0	1	04	01	H6743_007_0	7	Non-Preferred Brand	4	100000	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 Brand, Specialty Tier, Select Care Drugs												
H6743	007	0	1	04	01	H6743_007_0	7	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31				392.89	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6743	007	0	1	04	01	H6743_007_0	7	Select Care Drugs	4	010010	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												
H6743	014	0	1	04	01	H6743_014_0	7	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	10.00		20.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6743	014	0	1	04	01	H6743_014_0	7	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	20.00		40.00																					40.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6743	014	0	1	04	01	H6743_014_0	7	Preferred Brand	4	000001	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 Brand, Specialty Tier, Select Care Drugs												
H6743	014	0	1	04	01	H6743_014_0	7	Non-Preferred Brand	4	100000	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 Brand, Specialty Tier, Select Care Drugs												
H6743	014	0	1	04	01	H6743_014_0	7	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31				515.13	29																				29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6743	014	0	1	04	01	H6743_014_0	7	Select Care Drugs	4	010010	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												
H6743	016	0	1	04	01	H6743_016_0	7	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	6.00		12.00																					12.00																6.00				6.00		0.20						0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6743	016	0	1	04	01	H6743_016_0	7	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	15.00		30.00																					30.00																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6743	016	0	1	04	01	H6743_016_0	7	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	40.00		80.00																					80.00																40.00				40.00		1.33						1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6743	016	0	1	04	01	H6743_016_0	7	Non-Preferred Brand	4	100000	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	85.00		170.00																					170.00																85.00				85.00		2.83						2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6743	016	0	1	04	01	H6743_016_0	7	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31				465.10	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6743	016	0	1	04	01	H6743_016_0	7	Select Care Drugs	4	010010	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												
H6743	017	0	1	04	01	H6743_017_0	7	Preferred Generic	4	001000	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 Brand, Specialty Tier, Select Care Drugs												
H6743	017	0	1	04	01	H6743_017_0	7	Generic	4	010000	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 Brand, Specialty Tier, Select Care Drugs												
H6743	017	0	1	04	01	H6743_017_0	7	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	35.00		70.00																					70.00																35.00				35.00		1.17						1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6743	017	0	1	04	01	H6743_017_0	7	Non-Preferred Brand	4	100000	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	75.00		150.00																					150.00																75.00				75.00		2.50						2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6743	017	0	1	04	01	H6743_017_0	7	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31				653.39	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6743	017	0	1	04	01	H6743_017_0	7	Select Care Drugs	4	010010	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												
H6750	001	0	1	01	01	H6750_001_0	7	Preferred Generic	4	001000	3	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6750	001	0	1	01	01	H6750_001_0	7	Preferred Generic	4	001000	3	2	1	3	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		3
H6750	001	0	1	01	01	H6750_001_0	7	Generic	4	010000	3	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6750	001	0	1	01	01	H6750_001_0	7	Preferred Brand	4	000001	3	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					94.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6750	001	0	1	01	01	H6750_001_0	7	Non-Preferred Brand	4	100100	3	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6750	001	0	1	01	01	H6750_001_0	7	Specialty Tier	4	010010	1	1	5	1	111		01	010		1	30	60	90				1	1	30						30		31				300.00	29	29	29																		29																	29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6750	002	0	1	01	01	H6750_002_0	11	Preferred Generic	4	001000	3	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	0.00	0.00	0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6750	002	0	1	01	01	H6750_002_0	11	Generic	4	010000	3	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6750	002	0	1	01	01	H6750_002_0	11	Preferred Brand	4	000001	3	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					94.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6750	002	0	1	01	01	H6750_002_0	11	Non-Preferred Brand	4	100100	3	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6750	002	0	1	01	01	H6750_002_0	11	Specialty Tier	4	010010	1	1	5	1	111		01	010		1	30	60	90				1	1	30						30		31				300.00	27	27	27																		27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6751	001	0	1	48	05	H6751_001_0	5	Generic Drugs	4	010000			1	1	111		01	110		1	30	60	90				2	2	30		90				30		31																																																					Generic Drugs, Brand Drugs	3	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H6751	001	0	1	48	05	H6751_001_0	5	Brand Drugs	4	000010			2	1	111		01	110		1	30	60	90				2	2	30		90				30		31																																																					Generic Drugs, Brand Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H6786	002	0	1	04	01	H6786_002_0	7	Preferred Generic	3	001000	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												
H6786	002	0	1	04	01	H6786_002_0	7	Generic	3	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6786	002	0	1	04	01	H6786_002_0	7	Preferred Brand	3	000101	1	2	3	1		111	01	111		1				30	60	90	1	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												
H6786	002	0	1	04	01	H6786_002_0	7	Non-Preferred Drug	3	100100	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												
H6786	002	0	1	04	01	H6786_002_0	7	Specialty Tier	3	010010	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												
H6786	002	0	1	04	01	H6786_002_0	7	Select Care Drugs	3	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H6801	002	0	1	01	01	H6801_002_0	7	Preferred Generic	4	001000	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							27.00																9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6801	002	0	1	01	01	H6801_002_0	7	Preferred Generic	4	001000	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							27.00																9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H6801	002	0	1	01	01	H6801_002_0	7	Generic	4	010010	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								15.00		45.00					6.00		18.00							45.00																15.00				15.00			0.50	0.20				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6801	002	0	1	01	01	H6801_002_0	7	Generic	4	010010	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								15.00		45.00					6.00		18.00							45.00																15.00				15.00			0.50	0.20				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H6801	002	0	1	01	01	H6801_002_0	7	Preferred Brand	4	010001	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					39.00		117.00							141.00																47.00				47.00			1.57	1.30				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6801	002	0	1	01	01	H6801_002_0	7	Non-Preferred Brand	4	110000	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								99.00		297.00					85.00		255.00							297.00																99.00				99.00			3.30	2.83				3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6801	002	0	1	01	01	H6801_002_0	7	Specialty Tier	4	010010	1	1	5	1		110	01	100		1				30		90	1	2			90				30		31											728.11	33		33				728.80	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6801	006	0	1	02	01	H6801_006_0	7	Preferred Generic	4	001000	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							27.00																9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6801	006	0	1	02	01	H6801_006_0	7	Preferred Generic	4	001000	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							27.00																9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H6801	006	0	1	02	01	H6801_006_0	7	Generic	4	010010	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								15.00		45.00					6.00		18.00							45.00																15.00				15.00			0.50	0.20				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6801	006	0	1	02	01	H6801_006_0	7	Generic	4	010010	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								15.00		45.00					6.00		18.00							45.00																15.00				15.00			0.50	0.20				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H6801	006	0	1	02	01	H6801_006_0	7	Preferred Brand	4	010001	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					39.00		117.00							141.00																47.00				47.00			1.57	1.30				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6801	006	0	1	02	01	H6801_006_0	7	Non-Preferred Brand	4	110000	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								99.00		297.00					85.00		255.00							297.00																99.00				99.00			3.30	2.83				3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6801	006	0	1	02	01	H6801_006_0	7	Specialty Tier	4	010010	1	1	5	1		110	01	100		1				30		90	1	2			90				30		31											599.10	33		33				599.18	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6815	003	1	1	01	01	H6815_003_1	4	Preferred Generic	4	001000	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	6.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6815	003	1	1	01	01	H6815_003_1	4	Generic	4	010000	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	16.00				15.00				15.00			0.50	0.27		0.50	0.27	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6815	003	1	1	01	01	H6815_003_1	4	Preferred Brand	4	010001	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6815	003	1	1	01	01	H6815_003_1	4	Non-Preferred Brand	4	110000	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	225.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6815	003	1	1	01	01	H6815_003_1	4	Specialty Tier	4	010010	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	30				30	30	30			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6815	003	1	1	01	01	H6815_003_1	4	Select Care Drugs	4	010010	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6815	003	2	1	01	01	H6815_003_2	4	Preferred Generic	4	001000	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	6.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6815	003	2	1	01	01	H6815_003_2	4	Generic	4	010000	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	16.00				15.00				15.00			0.50	0.27		0.50	0.27	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6815	003	2	1	01	01	H6815_003_2	4	Preferred Brand	4	010001	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6815	003	2	1	01	01	H6815_003_2	4	Non-Preferred Brand	4	110000	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	225.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6815	003	2	1	01	01	H6815_003_2	4	Specialty Tier	4	010010	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	30				30	30	30			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6815	003	2	1	01	01	H6815_003_2	4	Select Care Drugs	4	010010	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6815	004	1	1	01	01	H6815_004_1	3	Preferred Generic	4	001000	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	6.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6815	004	1	1	01	01	H6815_004_1	3	Generic	4	010000	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	16.00				15.00				15.00			0.50	0.27		0.50	0.27	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6815	004	1	1	01	01	H6815_004_1	3	Preferred Brand	4	010001	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6815	004	1	1	01	01	H6815_004_1	3	Non-Preferred Brand	4	110000	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	225.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6815	004	1	1	01	01	H6815_004_1	3	Specialty Tier	4	010010	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												33	33	33					33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6815	004	1	1	01	01	H6815_004_1	3	Select Care Drugs	4	010010	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6815	004	2	1	01	01	H6815_004_2	3	Preferred Generic	4	001000	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	6.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6815	004	2	1	01	01	H6815_004_2	3	Generic	4	010000	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	16.00				15.00				15.00			0.50	0.27		0.50	0.27	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6815	004	2	1	01	01	H6815_004_2	3	Preferred Brand	4	010001	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	74.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6815	004	2	1	01	01	H6815_004_2	3	Non-Preferred Brand	4	110000	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	225.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6815	004	2	1	01	01	H6815_004_2	3	Specialty Tier	4	010010	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												33	33	33					33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6815	004	2	1	01	01	H6815_004_2	3	Select Care Drugs	4	010010	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H6859	001	0	1	01	01	H6859_001_0	5	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6859	001	0	1	01	01	H6859_001_0	5	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6859	001	0	1	01	01	H6859_001_0	5	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6859	001	0	1	01	01	H6859_001_0	5	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6859	001	0	1	01	01	H6859_001_0	5	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6859	001	0	1	01	01	H6859_001_0	5	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6859	001	0	1	01	01	H6859_001_0	5	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6859	001	0	1	01	01	H6859_001_0	5	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6859	001	0	1	01	01	H6859_001_0	5	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6859	001	0	1	01	01	H6859_001_0	5	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6859	003	0	1	01	01	H6859_003_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6859	003	0	1	01	01	H6859_003_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6859	003	0	1	01	01	H6859_003_0	3	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6859	003	0	1	01	01	H6859_003_0	3	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6859	003	0	1	01	01	H6859_003_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6859	003	0	1	01	01	H6859_003_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6859	003	0	1	01	01	H6859_003_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6859	003	0	1	01	01	H6859_003_0	3	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6859	003	0	1	01	01	H6859_003_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6859	003	0	1	01	01	H6859_003_0	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6859	004	0	1	01	01	H6859_004_0	5	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6859	004	0	1	01	01	H6859_004_0	5	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6859	004	0	1	01	01	H6859_004_0	5	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6859	004	0	1	01	01	H6859_004_0	5	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6859	004	0	1	01	01	H6859_004_0	5	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6859	004	0	1	01	01	H6859_004_0	5	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6859	004	0	1	01	01	H6859_004_0	5	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6859	004	0	1	01	01	H6859_004_0	5	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6859	004	0	1	01	01	H6859_004_0	5	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6859	004	0	1	01	01	H6859_004_0	5	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H6859	008	0	1	01	01	H6859_008_0	3	Preferred Generic	3	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					0.00		0.00											10.00		30.00				0.00		0.00				10.00				10.00			0.33	0		0.33	0	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6859	008	0	1	01	01	H6859_008_0	3	Generic	3	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					19.00		57.00											20.00		60.00				19.00		0.00				20.00				20.00			0.67	0.63		0.67	0.63	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6859	008	0	1	01	01	H6859_008_0	3	Preferred Brand	3	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6859	008	0	1	01	01	H6859_008_0	3	Non-Preferred Drug	3	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6859	008	0	1	01	01	H6859_008_0	3	Specialty Tier	3	010010	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												
H6864	001	0	1	01	01	H6864_001_0	12	Preferred Generic	2	001000	1	2	1	1	111		01	100		1	30	60	90				2	2			90				30		31	1.00	2.00	3.00																					2.00																1.00				1.00		0.03						0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6864	001	0	1	01	01	H6864_001_0	12	Generic	2	010000	1	2	2	1	111		01	100		1	30	60	90				2	2			90				30		31	6.00	12.00	18.00																					12.00																6.00				6.00		0.20						0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6864	001	0	1	01	01	H6864_001_0	12	Preferred Brand	2	000001	1	1	3	1	111		01	100		1	30	60	90				2	2			90				30		31				73.31	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6864	001	0	1	01	01	H6864_001_0	12	Non-Preferred Drug	2	110000	1	1	4	1	111		01	100		1	30	60	90				2	2			90				30		31				87.98	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6864	001	0	1	01	01	H6864_001_0	12	Specialty Tier	2	010010	1	1	5	1	111		01	100		1	30	60	90				2	2			90				30		31				853.68	25	25	25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6870	001	0	1	48	05	H6870_001_0	5	Generic Drugs	4	010000			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	5	Brand Drugs	4	000010			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	5	Non-Medicare Rx/OTC Drugs	4	010010			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			
H6947	001	0	1	01	01	H6947_001_0	6	Preferred Generic	4	001000	1	2	1	1	111		01	100		1	31	62	93				1	2			93				31		31	3.00	6.00	7.50																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6947	001	0	1	01	01	H6947_001_0	6	Generic	4	010000	1	2	2	1	111		01	100		1	31	62	93				1	2			93				31		31	15.00	30.00	37.50																					45.00																15.00				15.00		0.48						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6947	001	0	1	01	01	H6947_001_0	6	Preferred Brand	4	000001	1	2	3	1	111		01	100		1	31	62	93				1	2			93				31		31	47.00	94.00	117.50																					141.00																47.00				47.00		1.52						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6947	001	0	1	01	01	H6947_001_0	6	Non-Preferred Brand	4	100100	1	1	4	1	111		01	100		1	31	62	93				1	2			93				31		31				57.90	50	50	50																				50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6947	001	0	1	01	01	H6947_001_0	6	Specialty Tier	4	010010	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												
H6951	002	0	1	04	01	H6951_002_0	14	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	9.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6951	002	0	1	04	01	H6951_002_0	14	Generic	4	010000	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 Brand, Specialty Tier												
H6951	002	0	1	04	01	H6951_002_0	14	Preferred Brand	4	000001	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6951	002	0	1	04	01	H6951_002_0	14	Non-Preferred Brand	4	100000	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6951	002	0	1	04	01	H6951_002_0	14	Specialty Tier	4	010010	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												
H6972	001	0	1	01	01	H6972_001_0	4	Preferred Generic	4	001000	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		31								8.00	16.00	20.00					3.00	6.00	7.50					8.00		20.00																8.00				8.00			0.27	0.10	0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6972	001	0	1	01	01	H6972_001_0	4	Generic	4	010000	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		31								20.00	40.00	50.00					15.00	30.00	37.50					20.00		50.00																20.00				20.00			0.67	0.50	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6972	001	0	1	01	01	H6972_001_0	4	Preferred Brand	4	000101	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					47.00		141.00																47.00				47.00			1.57	1.40	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6972	001	0	1	01	01	H6972_001_0	4	Non-Preferred Drug	4	100100	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00		300.00																100.00				100.00			3.33	3.17	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6972	001	0	1	01	01	H6972_001_0	4	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		31											824.15	33						598.50	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H6988	001	0	1	01	01	H6988_001_0	14	Generic	4	010000	1	2	1	1	110		01	100		1	30		90				1	1			90				30		31	2.00		6.00																					5.00																2.00				2.00		0.07						0.06	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6988	001	0	1	01	01	H6988_001_0	14	Preferred Brand	4	000001	1	2	2	1	110		01	100		1	30		90				1	1			90				30		31	35.00		105.00																					87.50																35.00				35.00		1.17						1.13	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6988	001	0	1	01	01	H6988_001_0	14	Non-Preferred Brand	4	100000	1	2	3	1	110		01	100		1	30		90				1	1			90				30		31	85.00		255.00																					212.50																85.00				85.00		2.83						2.74	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H6988	001	0	1	01	01	H6988_001_0	14	Specialty Tier	4	110001	1	1	4	1	010		01			1	30														30		31					33																																					33			33								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7006	001	0	1	04	01	H7006_001_0	8	Preferred Generic	4	001000	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 Brand, Specialty Tier, Select Care Drugs												
H7006	001	0	1	04	01	H7006_001_0	8	Generic	4	010000	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 Brand, Specialty Tier, Select Care Drugs												
H7006	001	0	1	04	01	H7006_001_0	8	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	35.00		70.00																					70.00																35.00				35.00		1.17						1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7006	001	0	1	04	01	H7006_001_0	8	Non-Preferred Brand	4	100000	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	75.00		150.00																					150.00																75.00				75.00		2.50						2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7006	001	0	1	04	01	H7006_001_0	8	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31				760.87	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7006	001	0	1	04	01	H7006_001_0	8	Select Care Drugs	4	010010	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												
H7006	003	0	1	04	01	H7006_003_0	8	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	6.00		12.00																					12.00																6.00				6.00		0.20						0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7006	003	0	1	04	01	H7006_003_0	8	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	15.00		30.00																					30.00																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7006	003	0	1	04	01	H7006_003_0	8	Preferred Brand	4	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	40.00		80.00																					80.00																40.00				40.00		1.33						1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7006	003	0	1	04	01	H7006_003_0	8	Non-Preferred Brand	4	100000	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	85.00		170.00																					170.00																85.00				85.00		2.83						2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7006	003	0	1	04	01	H7006_003_0	8	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31				748.80	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7006	003	0	1	04	01	H7006_003_0	8	Select Care Drugs	4	010010	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												
H7020	003	1	1	01	01	H7020_003_1	4	Preferred Generic	4	001000	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		31								6.00	12.00	18.00					1.00	2.00	0.00					6.00		18.00																6.00				6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7020	003	1	1	01	01	H7020_003_1	4	Generic	4	010000	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		31								20.00	40.00	60.00					15.00	30.00	37.50					20.00		60.00																20.00				20.00			0.67	0.50	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7020	003	1	1	01	01	H7020_003_1	4	Preferred Brand	4	000101	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					47.00		141.00																47.00				47.00			1.57	1.40	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7020	003	1	1	01	01	H7020_003_1	4	Non-Preferred Drug	4	100100	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00		300.00																100.00				100.00			3.33	3.17	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7020	003	1	1	01	01	H7020_003_1	4	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		31											496.72	27						312.24	27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7020	003	2	1	01	01	H7020_003_2	4	Preferred Generic	4	001000	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		31								6.00	12.00	18.00					1.00	2.00	0.00					6.00		18.00																6.00				6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7020	003	2	1	01	01	H7020_003_2	4	Generic	4	010000	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		31								20.00	40.00	60.00					15.00	30.00	37.50					20.00		60.00																20.00				20.00			0.67	0.50	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7020	003	2	1	01	01	H7020_003_2	4	Preferred Brand	4	000101	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					47.00		141.00																47.00				47.00			1.57	1.40	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7020	003	2	1	01	01	H7020_003_2	4	Non-Preferred Drug	4	100100	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00		300.00																100.00				100.00			3.33	3.17	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7020	003	2	1	01	01	H7020_003_2	4	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		31											496.72	27						312.24	27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7115	001	0	1	01	01	H7115_001_0	10	Preferred Generic	4	001000	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	5.00	10.00	12.50																					10.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7115	001	0	1	01	01	H7115_001_0	10	Generic	4	010000	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	15.00	30.00	37.50																					30.00																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7115	001	0	1	01	01	H7115_001_0	10	Preferred Brand	4	000001	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	45.00	90.00	112.50																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7115	001	0	1	01	01	H7115_001_0	10	Non-Preferred Brand	4	100000	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	99.00	198.00	247.50																					198.00																99.00				99.00		3.30						3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7115	001	0	1	01	01	H7115_001_0	10	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31					27																				27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7149	001	0	1	01	01	H7149_001_0	5	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7149	001	0	1	01	01	H7149_001_0	5	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7149	001	0	1	01	01	H7149_001_0	5	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7149	001	0	1	01	01	H7149_001_0	5	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7149	001	0	1	01	01	H7149_001_0	5	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7149	001	0	1	01	01	H7149_001_0	5	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7149	001	0	1	01	01	H7149_001_0	5	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	27						1.00	27												27						27						27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7149	004	0	1	01	01	H7149_004_0	4	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7149	004	0	1	01	01	H7149_004_0	4	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7149	004	0	1	01	01	H7149_004_0	4	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7149	004	0	1	01	01	H7149_004_0	4	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7149	004	0	1	01	01	H7149_004_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7149	004	0	1	01	01	H7149_004_0	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7149	004	0	1	01	01	H7149_004_0	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	27						1.00	27												27						27						27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7172	001	0	1	48	05	H7172_001_0	5	Generic Drugs	4	010000			1	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H7172	001	0	1	48	05	H7172_001_0	5	Brand Drugs	4	000010			2	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H7172	001	0	1	48	05	H7172_001_0	5	Non-Medicare Rx/OTC Drugs	4	010010			3	1	111		10			1	30	60	90				1	2								29	31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00			0.00	0.00			
H7173	001	0	1	01	01	H7173_001_0	11	Preferred Generic	3	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7173	001	0	1	01	01	H7173_001_0	11	Generic	3	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	14.00	28.00	42.00																			14.00	28.00	42.00																14.00				14.00		0.47			0.47			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7173	001	0	1	01	01	H7173_001_0	11	Preferred Brand	3	010001	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	24.00	48.00	72.00																			24.00	48.00	72.00																24.00				24.00		0.80			0.80			0.77	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7173	001	0	1	01	01	H7173_001_0	11	Non-Preferred Brand	3	110000	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	225.00																75.00				75.00		2.50			2.50			2.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7173	001	0	1	01	01	H7173_001_0	11	Specialty Tier	3	010010	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 Brand, Specialty Tier, Select Care Drugs												
H7173	001	0	1	01	01	H7173_001_0	11	Select Care Drugs	3	010010	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7173	002	0	1	01	01	H7173_002_0	5	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7173	002	0	1	01	01	H7173_002_0	5	Preferred Generic	4	001000	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H7173	002	0	1	01	01	H7173_002_0	5	Generic	4	010000	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 Brand, Specialty Tier, Select Care Drugs												
H7173	002	0	1	01	01	H7173_002_0	5	Preferred Brand	4	010001	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 Brand, Specialty Tier, Select Care Drugs												
H7173	002	0	1	01	01	H7173_002_0	5	Non-Preferred Brand	4	110000	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				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 Brand, Specialty Tier, Select Care Drugs												
H7173	002	0	1	01	01	H7173_002_0	5	Specialty Tier	4	010010	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 Brand, Specialty Tier, Select Care Drugs												
H7173	002	0	1	01	01	H7173_002_0	5	Select Care Drugs	4	010010	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7173	002	0	1	01	01	H7173_002_0	5	Select Care Drugs	4	010010	1	2	6	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H7173	003	0	1	01	01	H7173_003_0	6	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7173	003	0	1	01	01	H7173_003_0	6	Preferred Generic	4	001000	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H7173	003	0	1	01	01	H7173_003_0	6	Generic	4	010000	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 Brand, Specialty Tier, Select Care Drugs												
H7173	003	0	1	01	01	H7173_003_0	6	Preferred Brand	4	010001	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 Brand, Specialty Tier, Select Care Drugs												
H7173	003	0	1	01	01	H7173_003_0	6	Non-Preferred Brand	4	110000	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	86.00	172.00	258.00																			86.00	172.00	258.00																86.00				86.00		2.87			2.87			2.77	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7173	003	0	1	01	01	H7173_003_0	6	Specialty Tier	4	010010	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 Brand, Specialty Tier, Select Care Drugs												
H7173	003	0	1	01	01	H7173_003_0	6	Select Care Drugs	4	010010	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7173	003	0	1	01	01	H7173_003_0	6	Select Care Drugs	4	010010	1	2	6	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H7200	006	0	1	01	01	H7200_006_0	7	Preferred Generic	4	001000	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												
H7200	006	0	1	01	01	H7200_006_0	7	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	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												
H7200	006	0	1	01	01	H7200_006_0	7	Preferred Brand	4	000101	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	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												
H7200	006	0	1	01	01	H7200_006_0	7	Non-Preferred Drug	4	100100	1	2	4	1		111	01	111		1				30	60	90	1	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												
H7200	006	0	1	01	01	H7200_006_0	7	Specialty Tier	4	010010	1	1	5	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												
H7200	006	0	1	01	01	H7200_006_0	7	Select Care Drugs	4	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7200	006	0	1	01	01	H7200_006_0	7	Select Care Drugs	4	001000	1	2	6	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		
H7200	007	0	1	01	01	H7200_007_0	7	Preferred Generic	4	001000	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												
H7200	007	0	1	01	01	H7200_007_0	7	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7200	007	0	1	01	01	H7200_007_0	7	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	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												
H7200	007	0	1	01	01	H7200_007_0	7	Non-Preferred Drug	4	100100	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								88.00	176.00	264.00					83.00	166.00	249.00					83.00	249.00	249.00																88.00				88.00			2.93	2.77	2.77			2.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7200	007	0	1	01	01	H7200_007_0	7	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7200	007	0	1	01	01	H7200_007_0	7	Select Care Drugs	4	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7200	007	0	1	01	01	H7200_007_0	7	Select Care Drugs	4	001000	1	2	6	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		
H7200	013	0	1	01	01	H7200_013_0	9	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								7.00	14.00	21.00					2.00	4.00	6.00					2.00	6.00	6.00																7.00				7.00			0.23	0.07	0.07			0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7200	013	0	1	01	01	H7200_013_0	9	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7200	013	0	1	01	01	H7200_013_0	9	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	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												
H7200	013	0	1	01	01	H7200_013_0	9	Non-Preferred Drug	4	100100	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								96.00	192.00	288.00					91.00	182.00	273.00					91.00	273.00	273.00																96.00				96.00			3.20	3.03	3.03			2.82	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7200	013	0	1	01	01	H7200_013_0	9	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7200	013	0	1	01	01	H7200_013_0	9	Select Care Drugs	4	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7200	013	0	1	01	01	H7200_013_0	9	Select Care Drugs	4	001000	1	2	6	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		
H7220	003	0	1	01	01	H7220_003_0	12	Preferred Generic	4	001000	1	2	1	1	110		01	110		1	30		90				1	2	30		90				30		31	6.00		18.00																			6.00		18.00																6.00				6.00		0.20			0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7220	003	0	1	01	01	H7220_003_0	12	Generic	4	010000	1	2	2	1	110		01	110		1	30		90				1	2	30		90				30		31	15.00		45.00																			15.00		45.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7220	003	0	1	01	01	H7220_003_0	12	Preferred Brand	4	010001	1	2	3	1	110		01	110		1	30		90				1	2	30		90				30		31	47.00		141.00																			47.00		141.00																47.00				47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7220	003	0	1	01	01	H7220_003_0	12	Non-Preferred Brand	4	110000	1	2	4	1	110		01	110		1	30		90				1	2	30		90				30		31	95.00		285.00																			95.00		285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7220	003	0	1	01	01	H7220_003_0	12	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31				1482.48	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7220	003	0	1	01	01	H7220_003_0	12	Select Care Drugs	4	010000	1	2	6	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7220	004	0	1	02	01	H7220_004_0	12	Preferred Generic	4	001000	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				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7220	004	0	1	02	01	H7220_004_0	12	Preferred Generic	4	001000	1	2	1	3	110		01	110		1	30		90				1	2	30		90				30		31	10.00		30.00																			10.00		30.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H7220	004	0	1	02	01	H7220_004_0	12	Generic	4	010000	1	2	2	1	110		01	110		1	30		90				1	2	30		90				30		31	8.00		24.00																			8.00		24.00																8.00				8.00		0.27			0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7220	004	0	1	02	01	H7220_004_0	12	Preferred Brand	4	010001	1	2	3	1	110		01	110		1	30		90				1	2	30		90				30		31	42.00		126.00																			42.00		126.00																42.00				42.00		1.40			1.40			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7220	004	0	1	02	01	H7220_004_0	12	Non-Preferred Brand	4	110000	1	2	4	1	110		01	110		1	30		90				1	2	30		90				30		31	95.00		285.00																			95.00		285.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7220	004	0	1	02	01	H7220_004_0	12	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31				2127.43	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	12	Select Care Drugs	4	010000	1	2	6	1	110		01	110		1	30		90				1	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H7245	001	0	1	01	01	H7245_001_0	16	Preferred Generic	3	001000	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								15.00	30.00	45.00					5.00	10.00	15.00											15.00	30.00	45.00				5.00	10.00	15.00				15.00				15.00			0.50	0.16		0.50	0.16	0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7245	001	0	1	01	01	H7245_001_0	16	Generic	3	010000	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								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			0.66	0.50		0.66	0.50	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7245	001	0	1	01	01	H7245_001_0	16	Preferred Brand	3	000001	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								45.00	90.00	135.00					45.00	90.00	135.00											45.00	90.00	135.00				45.00	90.00	135.00				45.00				45.00			1.50	1.50		1.50	1.50	1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7245	001	0	1	01	01	H7245_001_0	16	Non-Preferred Drug	3	100100	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											62.12	30	30	30				62.12	30	30	30										30	30	30				30	30	30			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7245	001	0	1	01	01	H7245_001_0	16	Specialty Tier	3	010010	1	1	5	1		010	01		010	1				30								30			30		34											1.00	26						1.00	26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7245	002	0	1	01	01	H7245_002_0	16	Preferred Generic	4	001000	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								12.00	24.00	36.00					4.00	8.00	12.00											12.00	24.00	36.00				4.00	8.00	12.00				12.00				12.00			0.40	0.13		0.40	0.13	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7245	002	0	1	01	01	H7245_002_0	16	Generic	4	010000	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					12.00	24.00	36.00											20.00	40.00	60.00				12.00	24.00	36.00				20.00				20.00			0.66	0.40		0.66	0.40	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7245	002	0	1	01	01	H7245_002_0	16	Preferred Brand	4	000001	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								45.00	90.00	135.00					45.00	90.00	135.00											45.00	90.00	135.00				45.00	90.00	135.00				45.00				45.00			1.50	1.50		1.50	1.50	1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7245	002	0	1	01	01	H7245_002_0	16	Non-Preferred Drug	4	100100	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											67.27	30	30	30				67.27	30	30	30										30	30	30				30	30	30			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7245	002	0	1	01	01	H7245_002_0	16	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		34											1.00	27						1.00	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7245	003	0	1	01	01	H7245_003_0	14	Preferred Generic	4	001000	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								12.00	24.00	36.00					4.00	8.00	12.00											12.00	24.00	36.00				4.00	8.00	12.00				12.00				12.00			0.40	0.13		0.40	0.13	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7245	003	0	1	01	01	H7245_003_0	14	Generic	4	010000	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					12.00	24.00	36.00											20.00	40.00	60.00				12.00	24.00	36.00				20.00				20.00			0.66	0.40		0.66	0.40	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7245	003	0	1	01	01	H7245_003_0	14	Preferred Brand	4	000001	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								45.00	90.00	135.00					45.00	90.00	135.00											45.00	90.00	135.00				45.00	90.00	135.00				45.00				45.00			1.50	1.50		1.50	1.50	1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7245	003	0	1	01	01	H7245_003_0	14	Non-Preferred Drug	4	100100	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											56.48	30	30	30				56.48	30	30	30										30	30	30				30	30	30			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7245	003	0	1	01	01	H7245_003_0	14	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		34											1.00	29						1.00	29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7301	002	0	1	04	01	H7301_002_0	4	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7301	002	0	1	04	01	H7301_002_0	4	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7301	002	0	1	04	01	H7301_002_0	4	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7301	002	0	1	04	01	H7301_002_0	4	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7301	002	0	1	04	01	H7301_002_0	4	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7301	002	0	1	04	01	H7301_002_0	4	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7301	002	0	1	04	01	H7301_002_0	4	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7301	006	0	1	04	01	H7301_006_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7301	006	0	1	04	01	H7301_006_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7301	006	0	1	04	01	H7301_006_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7301	006	0	1	04	01	H7301_006_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7301	006	0	1	04	01	H7301_006_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7301	006	0	1	04	01	H7301_006_0	3	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7301	006	0	1	04	01	H7301_006_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7301	007	0	1	04	01	H7301_007_0	5	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7301	007	0	1	04	01	H7301_007_0	5	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7301	007	0	1	04	01	H7301_007_0	5	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7301	007	0	1	04	01	H7301_007_0	5	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7301	007	0	1	04	01	H7301_007_0	5	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	5	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	5	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7419	001	0	1	48	05	H7419_001_0	3	Generic Drugs	4	010000			1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H7419	001	0	1	48	05	H7419_001_0	3	Brand Drugs	4	000010			2	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H7419	001	0	1	48	05	H7419_001_0	3	Non-Medicare Rx/OTC Drugs	4	010010			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			
H7522	001	0	1	04	01	H7522_001_0	12	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7522	001	0	1	04	01	H7522_001_0	12	Preferred Generic	4	001000	1	2	1	3	110		01	100		1	30		90				2	2			90				30		31	0.00		0.00																					0.00																0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H7522	001	0	1	04	01	H7522_001_0	12	Generic	4	010000	1	2	2	1	110		01	100		1	30		90				2	2			90				30		31	5.00		15.00																					10.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7522	001	0	1	04	01	H7522_001_0	12	Generic	4	010000	1	2	2	3	110		01	100		1	30		90				2	2			90				30		31	5.00		15.00																					10.00																5.00				5.00		0.17						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2		
H7522	001	0	1	04	01	H7522_001_0	12	Preferred Brand	4	000001	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 Brand, Specialty Tier												
H7522	001	0	1	04	01	H7522_001_0	12	Non-Preferred Brand	4	100000	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 Brand, Specialty Tier												
H7522	001	0	1	04	01	H7522_001_0	12	Specialty Tier	4	010010	1	1	5	1	110		01	100		1	30		90				2	2			90				30		31				721.81	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7678	001	0	1	01	01	H7678_001_0	10	Preferred Generic	4	001001	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	10	Preferred Generic	4	001001	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	10	Generic	4	010001	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												
H7678	001	0	1	01	01	H7678_001_0	10	Preferred Brand	4	000101	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												
H7678	001	0	1	01	01	H7678_001_0	10	Non-Preferred Drug	4	100100	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				85.38	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7678	001	0	1	01	01	H7678_001_0	10	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	31								31						31		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7680	001	0	1	01	01	H7680_001_0	11	Preferred Generic	4	001000	1	2	1	1	111		01	100		1	30	60	90				1	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												
H7680	001	0	1	01	01	H7680_001_0	11	Generic	4	010000	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 Brand, Specialty Tier												
H7680	001	0	1	01	01	H7680_001_0	11	Preferred Brand	4	000001	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												
H7680	001	0	1	01	01	H7680_001_0	11	Non-Preferred Brand	4	100000	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												
H7680	001	0	1	01	01	H7680_001_0	11	Specialty Tier	4	110001	1	1	5	1	010		10			1	30															10	31				670.00	29																																						29		29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7680	002	0	1	01	01	H7680_002_0	11	Preferred Generic	4	001000	1	2	1	1	111		01	100		1	30	60	90				1	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												
H7680	002	0	1	01	01	H7680_002_0	11	Preferred Generic	4	001000	1	2	1	3	111		01	100		1	30	60	90				1	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										1		
H7680	002	0	1	01	01	H7680_002_0	11	Generic	4	010000	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	8.00	16.00	24.00																					16.00																8.00				8.00		0.27						0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7680	002	0	1	01	01	H7680_002_0	11	Generic	4	010000	1	2	2	3	111		01	100		1	30	60	90				1	2			90				30		31	8.00	16.00	24.00																					16.00																8.00				8.00		0.27						0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H7680	002	0	1	01	01	H7680_002_0	11	Preferred Brand	4	000001	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	30.00	60.00	90.00																					60.00																30.00				30.00		1.00						0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7680	002	0	1	01	01	H7680_002_0	11	Non-Preferred Brand	4	100000	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	60.00	120.00	180.00																					120.00																60.00				60.00		2.00						1.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7680	002	0	1	01	01	H7680_002_0	11	Specialty Tier	4	110001	1	1	5	1	010		10			1	30															10	31				670.00	33																																						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7728	002	0	1	04	01	H7728_002_0	9	Preferred Generic	4	001000	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												
H7728	002	0	1	04	01	H7728_002_0	9	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7728	002	0	1	04	01	H7728_002_0	9	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	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												
H7728	002	0	1	04	01	H7728_002_0	9	Non-Preferred Drug	4	100100	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												
H7728	002	0	1	04	01	H7728_002_0	9	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		34												28							28						28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H7728	002	0	1	04	01	H7728_002_0	9	Select Care Drugs	4	001000	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			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	9	Select Care Drugs	4	001000	1	2	6	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		
H7787	001	0	1	04	01	H7787_001_0	3	Preferred Generic	4	001000	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		31								5.00	10.00	12.50					0.00	0.00	0.00					5.00		12.50																5.00				5.00			0.17	0.00	0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7787	001	0	1	04	01	H7787_001_0	3	Generic	4	010000	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		31								9.00	18.00	22.50					4.00	8.00	10.00					9.00		22.50																9.00				9.00			0.30	0.13	0.30			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7787	001	0	1	04	01	H7787_001_0	3	Preferred Brand	4	000101	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		31								45.00	90.00	135.00					40.00	80.00	120.00					45.00		135.00																45.00				45.00			1.50	1.33	1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7787	001	0	1	04	01	H7787_001_0	3	Non-Preferred Drug	4	100100	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		31								85.00	170.00	255.00					80.00	160.00	240.00					85.00		255.00																85.00				85.00			2.83	2.67	2.83			2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7787	001	0	1	04	01	H7787_001_0	3	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		31											617.38	33						430.57	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7833	001	0	1	48	05	H7833_001_0	3	Generic Drugs	4	010000			1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	3.30	0.00	3.30	0.00	3.30	0.00	3.30			
H7833	001	0	1	48	05	H7833_001_0	3	Brand Drugs	4	000010			2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	8.25	0.00	8.25	0.00	8.25	0.00	8.25			
H7833	001	0	1	48	05	H7833_001_0	3	Non-Medicare Rx/OTC Drugs	4	010010			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	3	Generic Drugs	4	010000			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	3	Brand Drugs	4	010010			2	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	3	Non-Medicare Rx/OTC Drugs	4	010010			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			
H7885	001	0	1	48	05	H7885_001_0	10	Generic Drugs	4	010000			1	1	110		01			1	31		93				2	2							31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	3.30	0.00	3.30			0.00	3.30			
H7885	001	0	1	48	05	H7885_001_0	10	Brand Drugs	4	000010			2	1	110		01			1	31		93				2	2							31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	8.25	0.00	8.25			0.00	8.25			
H7885	001	0	1	48	05	H7885_001_0	10	Non-Medicare Rx/OTC Drugs	4	010010			3	1	110		01			1	31		93				1	2							31		31																																														0.00						0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00			0.00	0.00			
H7890	001	0	1	48	05	H7890_001_0	8	Generic Drugs	4	010000			1	1	110		01	110		1	31		90				1	2	31		90				31		31																																														0.11			0.11			0.11	Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	0.00	3.30	0.00	3.30	0.00	3.30	0.00	3.30			
H7890	001	0	1	48	05	H7890_001_0	8	Brand Drugs	4	000010			2	1	110		01	110		1	31		90				1	2	31		90				31		31																																														0.27			0.27			0.27	Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	0.00	8.25	0.00	8.25	0.00	8.25	0.00	8.25			
H7890	001	0	1	48	05	H7890_001_0	8	Non-Medicare Rx Drugs	4	010010			3	1	010		01	010		1	31								31						31		31																																														0.00			0.00			0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H7890	001	0	1	48	05	H7890_001_0	8	Non-Medicare OTC Drugs	4	010010			4	1	110		01	110		1	31		90				1	2	31		90				31		31																																														0.00			0.00			0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H7917	008	0	1	04	01	H7917_008_0	8	Preferred Generic	4	001000	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	008	0	1	04	01	H7917_008_0	8	Preferred Generic	4	001000	1	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7917	008	0	1	04	01	H7917_008_0	8	Generic	4	010000	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					14	31	6.00	12.00	15.00																			6.00	12.00	15.00																	6.00			6.00		0.20			0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	008	0	1	04	01	H7917_008_0	8	Preferred Brand	4	010001	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					14	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 Drug, Specialty Tier												
H7917	008	0	1	04	01	H7917_008_0	8	Non-Preferred Drug	4	110000	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					14	31	50.00	100.00	125.00																			50.00	100.00	125.00																	50.00			50.00		1.67			1.67			1.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	008	0	1	04	01	H7917_008_0	8	Specialty Tier	4	010010	1	1	5	1	111		10	111		1	30	60	90				2	2	30	60	90					14	31					33	33	33																		33	33	33																33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	009	0	1	04	01	H7917_009_0	9	Preferred Generic	4	001000	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	009	0	1	04	01	H7917_009_0	9	Preferred Generic	4	001000	1	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7917	009	0	1	04	01	H7917_009_0	9	Generic	4	010000	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					14	31	6.00	12.00	15.00																			6.00	12.00	15.00																	6.00			6.00		0.20			0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	009	0	1	04	01	H7917_009_0	9	Preferred Brand	4	010001	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					14	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 Drug, Specialty Tier												
H7917	009	0	1	04	01	H7917_009_0	9	Non-Preferred Drug	4	110000	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					14	31	50.00	100.00	125.00																			50.00	100.00	125.00																	50.00			50.00		1.67			1.67			1.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	009	0	1	04	01	H7917_009_0	9	Specialty Tier	4	010010	1	1	5	1	111		10	111		1	30	60	90				2	2	30	60	90					14	31					33	33	33																		33	33	33																33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	010	0	1	04	01	H7917_010_0	8	Preferred Generic	4	001000	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	010	0	1	04	01	H7917_010_0	8	Preferred Generic	4	001000	1	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7917	010	0	1	04	01	H7917_010_0	8	Generic	4	010000	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					14	31	6.00	12.00	15.00																			6.00	12.00	15.00																	6.00			6.00		0.20			0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	010	0	1	04	01	H7917_010_0	8	Preferred Brand	4	010001	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					14	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 Drug, Specialty Tier												
H7917	010	0	1	04	01	H7917_010_0	8	Non-Preferred Drug	4	110000	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					14	31	50.00	100.00	125.00																			50.00	100.00	125.00																	50.00			50.00		1.67			1.67			1.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	010	0	1	04	01	H7917_010_0	8	Specialty Tier	4	010010	1	1	5	1	111		10	111		1	30	60	90				2	2	30	60	90					14	31					33	33	33																		33	33	33																33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	011	0	1	04	01	H7917_011_0	8	Preferred Generic	4	001000	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	011	0	1	04	01	H7917_011_0	8	Preferred Generic	4	001000	1	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7917	011	0	1	04	01	H7917_011_0	8	Generic	4	010000	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					14	31	6.00	12.00	15.00																			6.00	12.00	15.00																	6.00			6.00		0.20			0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	011	0	1	04	01	H7917_011_0	8	Preferred Brand	4	010001	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					14	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 Drug, Specialty Tier												
H7917	011	0	1	04	01	H7917_011_0	8	Non-Preferred Drug	4	110000	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					14	31	50.00	100.00	125.00																			50.00	100.00	125.00																	50.00			50.00		1.67			1.67			1.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	011	0	1	04	01	H7917_011_0	8	Specialty Tier	4	010010	1	1	5	1	111		10	111		1	30	60	90				2	2	30	60	90					14	31					33	33	33																		33	33	33																33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	012	0	1	04	01	H7917_012_0	8	Preferred Generic	4	001000	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	012	0	1	04	01	H7917_012_0	8	Preferred Generic	4	001000	1	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7917	012	0	1	04	01	H7917_012_0	8	Generic	4	010000	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					14	31	6.00	12.00	15.00																			6.00	12.00	15.00																	6.00			6.00		0.20			0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	012	0	1	04	01	H7917_012_0	8	Preferred Brand	4	010001	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					14	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 Drug, Specialty Tier												
H7917	012	0	1	04	01	H7917_012_0	8	Non-Preferred Drug	4	110000	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					14	31	65.00	130.00	162.50																			65.00	130.00	162.50																	65.00			65.00		2.17			2.17			2.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	012	0	1	04	01	H7917_012_0	8	Specialty Tier	4	010010	1	1	5	1	111		10	111		1	30	60	90				2	2	30	60	90					14	31					33	33	33																		33	33	33																33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	013	0	1	04	01	H7917_013_0	7	Preferred Generic	4	001000	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	013	0	1	04	01	H7917_013_0	7	Preferred Generic	4	001000	1	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7917	013	0	1	04	01	H7917_013_0	7	Generic	4	010000	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					14	31	6.00	12.00	15.00																			6.00	12.00	15.00																	6.00			6.00		0.20			0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	013	0	1	04	01	H7917_013_0	7	Preferred Brand	4	010001	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					14	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 Drug, Specialty Tier												
H7917	013	0	1	04	01	H7917_013_0	7	Non-Preferred Drug	4	110000	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					14	31	65.00	130.00	162.50																			65.00	130.00	162.50																	65.00			65.00		2.17			2.17			2.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	013	0	1	04	01	H7917_013_0	7	Specialty Tier	4	010010	1	1	5	1	111		10	111		1	30	60	90				2	2	30	60	90					14	31					33	33	33																		33	33	33																33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	014	0	1	04	01	H7917_014_0	6	Preferred Generic	4	001000	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	014	0	1	04	01	H7917_014_0	6	Preferred Generic	4	001000	1	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7917	014	0	1	04	01	H7917_014_0	6	Generic	4	010000	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					14	31	6.00	12.00	15.00																			6.00	12.00	15.00																	6.00			6.00		0.20			0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	014	0	1	04	01	H7917_014_0	6	Preferred Brand	4	010001	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					14	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 Drug, Specialty Tier												
H7917	014	0	1	04	01	H7917_014_0	6	Non-Preferred Drug	4	110000	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					14	31	65.00	130.00	162.50																			65.00	130.00	162.50																	65.00			65.00		2.17			2.17			2.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	014	0	1	04	01	H7917_014_0	6	Specialty Tier	4	010010	1	1	5	1	111		10	111		1	30	60	90				2	2	30	60	90					14	31					33	33	33																		33	33	33																33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	015	0	1	04	01	H7917_015_0	7	Preferred Generic	4	001000	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	015	0	1	04	01	H7917_015_0	7	Preferred Generic	4	001000	1	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7917	015	0	1	04	01	H7917_015_0	7	Generic	4	010000	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					14	31	6.00	12.00	15.00																			6.00	12.00	15.00																	6.00			6.00		0.20			0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	015	0	1	04	01	H7917_015_0	7	Preferred Brand	4	010001	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					14	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 Drug, Specialty Tier												
H7917	015	0	1	04	01	H7917_015_0	7	Non-Preferred Drug	4	110000	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					14	31	65.00	130.00	162.50																			65.00	130.00	162.50																	65.00			65.00		2.17			2.17			2.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	015	0	1	04	01	H7917_015_0	7	Specialty Tier	4	010010	1	1	5	1	111		10	111		1	30	60	90				2	2	30	60	90					14	31					33	33	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	6	Preferred Generic	4	001000	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	030	0	1	04	01	H7917_030_0	6	Preferred Generic	4	001000	1	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7917	030	0	1	04	01	H7917_030_0	6	Generic	4	010000	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					14	31	12.00	24.00	30.00																			12.00	24.00	30.00																	12.00			12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	030	0	1	04	01	H7917_030_0	6	Preferred Brand	4	010001	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					14	31	45.00	90.00	112.50																			45.00	90.00	112.50																	45.00			45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	030	0	1	04	01	H7917_030_0	6	Non-Preferred Drug	4	110000	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					14	31	90.00	180.00	225.00																			90.00	180.00	225.00																	90.00			90.00		3.00			3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	030	0	1	04	01	H7917_030_0	6	Specialty Tier	4	010010	1	1	5	1	111		10	111		1	30	60	90				2	2	30	60	90					14	31					33	33	33																		33	33	33																33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	031	0	1	04	01	H7917_031_0	7	Preferred Generic	4	001000	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	031	0	1	04	01	H7917_031_0	7	Preferred Generic	4	001000	1	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7917	031	0	1	04	01	H7917_031_0	7	Generic	4	010000	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					14	31	12.00	24.00	30.00																			12.00	24.00	30.00																	12.00			12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	031	0	1	04	01	H7917_031_0	7	Preferred Brand	4	010001	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					14	31	45.00	90.00	112.50																			45.00	90.00	112.50																	45.00			45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	031	0	1	04	01	H7917_031_0	7	Non-Preferred Drug	4	110000	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					14	31	90.00	180.00	225.00																			90.00	180.00	225.00																	90.00			90.00		3.00			3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	031	0	1	04	01	H7917_031_0	7	Specialty Tier	4	010010	1	1	5	1	111		10	111		1	30	60	90				2	2	30	60	90					14	31					33	33	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	8	Preferred Generic	4	001000	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	032	0	1	04	01	H7917_032_0	8	Preferred Generic	4	001000	1	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7917	032	0	1	04	01	H7917_032_0	8	Generic	4	010000	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					14	31	12.00	24.00	30.00																			12.00	24.00	30.00																	12.00			12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	032	0	1	04	01	H7917_032_0	8	Preferred Brand	4	010001	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					14	31	45.00	90.00	112.50																			45.00	90.00	112.50																	45.00			45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	032	0	1	04	01	H7917_032_0	8	Non-Preferred Drug	4	110000	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					14	31	90.00	180.00	225.00																			90.00	180.00	225.00																	90.00			90.00		3.00			3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	032	0	1	04	01	H7917_032_0	8	Specialty Tier	4	010010	1	1	5	1	111		10	111		1	30	60	90				2	2	30	60	90					14	31					33	33	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	8	Preferred Generic	4	001000	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	033	0	1	04	01	H7917_033_0	8	Preferred Generic	4	001000	1	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H7917	033	0	1	04	01	H7917_033_0	8	Generic	4	010000	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					14	31	12.00	24.00	30.00																			12.00	24.00	30.00																	12.00			12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	033	0	1	04	01	H7917_033_0	8	Preferred Brand	4	010001	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					14	31	45.00	90.00	112.50																			45.00	90.00	112.50																	45.00			45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	033	0	1	04	01	H7917_033_0	8	Non-Preferred Drug	4	110000	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					14	31	90.00	180.00	225.00																			90.00	180.00	225.00																	90.00			90.00		3.00			3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7917	033	0	1	04	01	H7917_033_0	8	Specialty Tier	4	010010	1	1	5	1	111		10	111		1	30	60	90				2	2	30	60	90					14	31					33	33	33																		33	33	33																33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H7960	001	0	1	01	01	H7960_001_0	7	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	12.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7960	001	0	1	01	01	H7960_001_0	7	Preferred Generic	4	001000	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	12.00																			4.00	8.00	12.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H7960	001	0	1	01	01	H7960_001_0	7	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	30.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7960	001	0	1	01	01	H7960_001_0	7	Preferred Brand	4	000001	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7960	001	0	1	01	01	H7960_001_0	7	Non-Preferred Brand	4	100000	1	2	4	1	111		01	111		1	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												
H7960	001	0	1	01	01	H7960_001_0	7	Specialty Tier	4	110001	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												
H7960	002	0	1	01	01	H7960_002_0	6	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	30.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7960	002	0	1	01	01	H7960_002_0	6	Generic	4	010000	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 Brand, Specialty Tier												
H7960	002	0	1	01	01	H7960_002_0	6	Preferred Brand	4	000001	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H7960	002	0	1	01	01	H7960_002_0	6	Non-Preferred Brand	4	100000	1	2	4	1	111		01	111		1	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												
H7960	002	0	1	01	01	H7960_002_0	6	Specialty Tier	4	110001	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												
H8016	001	0	1	48	05	H8016_001_0	8	Generic Drugs	4	010000			1	1	111		01			1	30	60	90				1	2							30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	3.30	0.00	3.30			0.00	3.30			
H8016	001	0	1	48	05	H8016_001_0	8	Brand Drugs	4	000010			2	1	111		01			1	30	60	90				1	2							30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	8.25	0.00	8.25			0.00	8.25			
H8016	001	0	1	48	05	H8016_001_0	8	Non-Medicare Rx/OTC Drugs	4	010010			3	1	111		01			1	30	60	90				1	2							30		31																																														0.00						0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00			0.00	0.00			
H8026	001	0	1	48	05	H8026_001_0	2	Generic Drugs	4	010000			1	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8026	001	0	1	48	05	H8026_001_0	2	Brand Drugs	4	000010			2	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8026	001	0	1	48	05	H8026_001_0	2	Non-Medicare Rx/OTC Drugs	4	010010			3	1	111		10	111		1	30	60	90				1	2	30	60	90					29	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			
H8029	001	0	1	48	05	H8029_001_0	4	Generic Drugs	4	010010			1	1	111		01	100		1	30	60	90				1	2			90				30		31																																														0.00						0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8029	001	0	1	48	05	H8029_001_0	4	Brand Drugs	4	010010			2	1	111		01	100		1	30	60	90				1	2			90				30		31																																														0.00						0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8029	001	0	1	48	05	H8029_001_0	4	Non-Medicare Rx/OTC Drugs	4	010010			3	1	111		01	100		1	30	60	90				1	2			90				30		31																																														0.00						0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8046	001	0	1	48	05	H8046_001_0	4	Generic Drugs	4	010000			1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31																																														0.00			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			
H8046	001	0	1	48	05	H8046_001_0	4	Brand Drugs	4	010010			2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31																																														0.00			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			
H8046	001	0	1	48	05	H8046_001_0	4	Non-Medicare Rx/OTC Drugs	4	010010			3	1	010		01	010		1	31								31						31		31																																														0.00			0.00			0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8056	001	0	1	48	05	H8056_001_0	3	Generic Drugs	4	010000			1	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31																																														0.00			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			
H8056	001	0	1	48	05	H8056_001_0	3	Brand Drugs	4	000010			2	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31																																														0.00			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			
H8056	001	0	1	48	05	H8056_001_0	3	Non-Medicare Rx/OTC Drugs	4	010010			3	1	111		10	111		1	30	60	90				1	2	30	60	90					29	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			
H8064	002	0	1	04	01	H8064_002_0	7	Preferred Generic	4	101001	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	7.00	14.00	21.00																			7.00	0.00	0.00																7.00				7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8064	002	0	1	04	01	H8064_002_0	7	Preferred Generic	4	101001	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	7.00	14.00	21.00																			0.00	0.00	0.00																7.00				7.00		0.23			0.00			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8064	002	0	1	04	01	H8064_002_0	7	Generic	4	110001	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 Brand, Specialty Tier												
H8064	002	0	1	04	01	H8064_002_0	7	Preferred Brand	4	110001	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8064	002	0	1	04	01	H8064_002_0	7	Non-Preferred Brand	4	110001	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	225.00																90.00				90.00		3.00			3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8064	002	0	1	04	01	H8064_002_0	7	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31				750.00	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8091	002	0	1	04	01	H8091_002_0	8	Preferred Generic	4	001000	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								10.00		20.00					3.00		6.00					3.00		6.00																10.00				3.00			0.33	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8091	002	0	1	04	01	H8091_002_0	8	Preferred Generic	4	001000	1	2	1	3		110	01	110		1				30		90	1	2	30		90				30		31								10.00		20.00					3.00		6.00					3.00		6.00																10.00				3.00			0.33	0.10	0.03			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8091	002	0	1	04	01	H8091_002_0	8	Generic	4	010000	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								18.00		36.00					13.00		26.00					13.00		26.00																18.00				13.00			0.60	0.43	0.43			0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8091	002	0	1	04	01	H8091_002_0	8	Preferred Brand	4	000001	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								40.00		80.00					35.00		70.00					35.00		70.00																40.00				35.00			1.33	1.17	1.17			1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8091	002	0	1	04	01	H8091_002_0	8	Non-Preferred Brand	4	110000	1	2	4	1		110	01	110		1				30		90	1	2	30		90				30		31								100.00		200.00					95.00		190.00					95.00		190.00																100.00				95.00			3.33	3.17	3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8091	002	0	1	04	01	H8091_002_0	8	Specialty Tier	4	010010	1	1	5	1		110	01	110		1				30		90	1	2	30		90				30		31											1.00	33		33				1.00	33		33				33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8091	004	0	1	04	01	H8091_004_0	8	Preferred Generic	4	001000	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								10.00		20.00					3.00		6.00					3.00		6.00																10.00				3.00			0.33	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8091	004	0	1	04	01	H8091_004_0	8	Generic	4	010000	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								18.00		36.00					13.00		26.00					13.00		26.00																18.00				13.00			0.60	0.43	0.43			0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8091	004	0	1	04	01	H8091_004_0	8	Preferred Brand	4	000001	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								40.00		80.00					35.00		70.00					35.00		70.00																40.00				35.00			1.33	1.17	1.17			1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8091	004	0	1	04	01	H8091_004_0	8	Non-Preferred Brand	4	110000	1	2	4	1		110	01	110		1				30		90	1	2	30		90				30		31								100.00		200.00					95.00		190.00					95.00		190.00																100.00				95.00			3.33	3.17	3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8091	004	0	1	04	01	H8091_004_0	8	Specialty Tier	4	010010	1	1	5	1		110	01	110		1				30		90	1	2	30		90				30		31											1.00	25		25				1.00	25		25				25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8130	001	0	1	01	01	H8130_001_0	10	Preferred Generic	4	001001	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	10	Preferred Generic	4	001001	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	10	Generic	4	010001	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	10	Generic	4	010001	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	10	Preferred Brand	4	000101	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	10	Non-Preferred Drug	4	100100	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				88.21	47	47	47																		47	47	47															47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8130	001	0	1	01	01	H8130_001_0	10	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	31								31						31		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8133	001	0	1	01	01	H8133_001_0	7	Preferred Generic	4	001000	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							27.00																9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	001	0	1	01	01	H8133_001_0	7	Preferred Generic	4	001000	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							27.00																9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8133	001	0	1	01	01	H8133_001_0	7	Generic	4	010010	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		60.00					9.00		27.00							60.00																20.00				20.00			0.67	0.30				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	001	0	1	01	01	H8133_001_0	7	Generic	4	010010	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								20.00		60.00					9.00		27.00							60.00																20.00				20.00			0.67	0.30				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8133	001	0	1	01	01	H8133_001_0	7	Preferred Brand	4	010001	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					39.00		117.00							141.00																47.00				47.00			1.57	1.30				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	001	0	1	01	01	H8133_001_0	7	Non-Preferred Brand	4	110000	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								100.00		300.00					95.00		285.00							300.00																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	001	0	1	01	01	H8133_001_0	7	Specialty Tier	4	010010	1	1	5	1		110	01	100		1				30		90	1	2			90				30		31											722.02	33		33				738.46	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	003	0	1	01	01	H8133_003_0	7	Preferred Generic	4	001000	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							27.00																9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	003	0	1	01	01	H8133_003_0	7	Preferred Generic	4	001000	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							27.00																9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8133	003	0	1	01	01	H8133_003_0	7	Generic	4	010010	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		60.00					9.00		27.00							60.00																20.00				20.00			0.67	0.30				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	003	0	1	01	01	H8133_003_0	7	Generic	4	010010	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								20.00		60.00					9.00		27.00							60.00																20.00				20.00			0.67	0.30				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8133	003	0	1	01	01	H8133_003_0	7	Preferred Brand	4	010001	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					39.00		117.00							141.00																47.00				47.00			1.57	1.30				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	003	0	1	01	01	H8133_003_0	7	Non-Preferred Brand	4	110000	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								100.00		300.00					95.00		285.00							300.00																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	003	0	1	01	01	H8133_003_0	7	Specialty Tier	4	010010	1	1	5	1		110	01	100		1				30		90	1	2			90				30		31											656.35	33		33				661.88	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	004	0	1	01	01	H8133_004_0	7	Preferred Generic	4	001000	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							27.00																9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	004	0	1	01	01	H8133_004_0	7	Preferred Generic	4	001000	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							27.00																9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8133	004	0	1	01	01	H8133_004_0	7	Generic	4	010010	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		60.00					9.00		27.00							60.00																20.00				20.00			0.67	0.30				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	004	0	1	01	01	H8133_004_0	7	Generic	4	010010	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								20.00		60.00					9.00		27.00							60.00																20.00				20.00			0.67	0.30				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8133	004	0	1	01	01	H8133_004_0	7	Preferred Brand	4	010001	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					39.00		117.00							141.00																47.00				47.00			1.57	1.30				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	004	0	1	01	01	H8133_004_0	7	Non-Preferred Brand	4	110000	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								100.00		300.00					95.00		285.00							300.00																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	004	0	1	01	01	H8133_004_0	7	Specialty Tier	4	010010	1	1	5	1		110	01	100		1				30		90	1	2			90				30		31											667.00	33		33				673.33	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	005	0	1	01	01	H8133_005_0	8	Preferred Generic	4	001000	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							27.00																9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	005	0	1	01	01	H8133_005_0	8	Preferred Generic	4	001000	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							27.00																9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8133	005	0	1	01	01	H8133_005_0	8	Generic	4	010010	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		60.00					9.00		27.00							60.00																20.00				20.00			0.67	0.30				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	005	0	1	01	01	H8133_005_0	8	Generic	4	010010	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								20.00		60.00					9.00		27.00							60.00																20.00				20.00			0.67	0.30				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8133	005	0	1	01	01	H8133_005_0	8	Preferred Brand	4	010001	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					39.00		117.00							141.00																47.00				47.00			1.57	1.30				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	005	0	1	01	01	H8133_005_0	8	Non-Preferred Brand	4	110000	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								100.00		300.00					95.00		285.00							300.00																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	005	0	1	01	01	H8133_005_0	8	Specialty Tier	4	010010	1	1	5	1		110	01	100		1				30		90	1	2			90				30		31											659.97	33		33				665.92	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	006	0	1	01	01	H8133_006_0	8	Preferred Generic	4	001000	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							27.00																9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	006	0	1	01	01	H8133_006_0	8	Preferred Generic	4	001000	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							27.00																9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8133	006	0	1	01	01	H8133_006_0	8	Generic	4	010010	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		60.00					9.00		27.00							60.00																20.00				20.00			0.67	0.30				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	006	0	1	01	01	H8133_006_0	8	Generic	4	010010	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								20.00		60.00					9.00		27.00							60.00																20.00				20.00			0.67	0.30				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8133	006	0	1	01	01	H8133_006_0	8	Preferred Brand	4	010001	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					39.00		117.00							141.00																47.00				47.00			1.57	1.30				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	006	0	1	01	01	H8133_006_0	8	Non-Preferred Brand	4	110000	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								100.00		300.00					95.00		285.00							300.00																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	006	0	1	01	01	H8133_006_0	8	Specialty Tier	4	010010	1	1	5	1		110	01	100		1				30		90	1	2			90				30		31											659.39	33		33				665.28	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	007	0	1	01	01	H8133_007_0	8	Preferred Generic	4	001000	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							27.00																9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	007	0	1	01	01	H8133_007_0	8	Preferred Generic	4	001000	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							27.00																9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8133	007	0	1	01	01	H8133_007_0	8	Generic	4	010010	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		60.00					9.00		27.00							60.00																20.00				20.00			0.67	0.30				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	007	0	1	01	01	H8133_007_0	8	Generic	4	010010	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								20.00		60.00					9.00		27.00							60.00																20.00				20.00			0.67	0.30				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8133	007	0	1	01	01	H8133_007_0	8	Preferred Brand	4	010001	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					39.00		117.00							141.00																47.00				47.00			1.57	1.30				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	007	0	1	01	01	H8133_007_0	8	Non-Preferred Brand	4	110000	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								100.00		300.00					95.00		285.00							300.00																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	007	0	1	01	01	H8133_007_0	8	Specialty Tier	4	010010	1	1	5	1		110	01	100		1				30		90	1	2			90				30		31											666.54	33		33				672.87	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	008	0	1	01	01	H8133_008_0	8	Preferred Generic	4	001000	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							27.00																9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	008	0	1	01	01	H8133_008_0	8	Preferred Generic	4	001000	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							27.00																9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8133	008	0	1	01	01	H8133_008_0	8	Generic	4	010010	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		60.00					9.00		27.00							60.00																20.00				20.00			0.67	0.30				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	008	0	1	01	01	H8133_008_0	8	Generic	4	010010	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								20.00		60.00					9.00		27.00							60.00																20.00				20.00			0.67	0.30				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8133	008	0	1	01	01	H8133_008_0	8	Preferred Brand	4	010001	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					39.00		117.00							141.00																47.00				47.00			1.57	1.30				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	008	0	1	01	01	H8133_008_0	8	Non-Preferred Brand	4	110000	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								100.00		300.00					95.00		285.00							300.00																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	008	0	1	01	01	H8133_008_0	8	Specialty Tier	4	010010	1	1	5	1		110	01	100		1				30		90	1	2			90				30		31											665.51	33		33				671.80	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	011	0	1	01	01	H8133_011_0	7	Preferred Generic	4	001000	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							27.00																9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	011	0	1	01	01	H8133_011_0	7	Preferred Generic	4	001000	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							27.00																9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8133	011	0	1	01	01	H8133_011_0	7	Generic	4	010010	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		60.00					9.00		27.00							60.00																20.00				20.00			0.67	0.30				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	011	0	1	01	01	H8133_011_0	7	Generic	4	010010	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								20.00		60.00					9.00		27.00							60.00																20.00				20.00			0.67	0.30				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8133	011	0	1	01	01	H8133_011_0	7	Preferred Brand	4	010001	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					39.00		117.00							141.00																47.00				47.00			1.57	1.30				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	011	0	1	01	01	H8133_011_0	7	Non-Preferred Brand	4	110000	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								100.00		300.00					95.00		285.00							300.00																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	011	0	1	01	01	H8133_011_0	7	Specialty Tier	4	010010	1	1	5	1		110	01	100		1				30		90	1	2			90				30		31											661.88	33		33				667.99	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	012	0	1	02	01	H8133_012_0	8	Preferred Generic	4	001000	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							27.00																9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	012	0	1	02	01	H8133_012_0	8	Preferred Generic	4	001000	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							27.00																9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8133	012	0	1	02	01	H8133_012_0	8	Generic	4	010010	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		60.00					9.00		27.00							60.00																20.00				20.00			0.67	0.30				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	012	0	1	02	01	H8133_012_0	8	Generic	4	010010	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								20.00		60.00					9.00		27.00							60.00																20.00				20.00			0.67	0.30				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8133	012	0	1	02	01	H8133_012_0	8	Preferred Brand	4	010001	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					39.00		117.00							141.00																47.00				47.00			1.57	1.30				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	012	0	1	02	01	H8133_012_0	8	Non-Preferred Brand	4	110000	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								100.00		300.00					95.00		285.00							300.00																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	012	0	1	02	01	H8133_012_0	8	Specialty Tier	4	010010	1	1	5	1		110	01	100		1				30		90	1	2			90				30		31											661.88	33		33				667.99	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	013	0	1	02	01	H8133_013_0	8	Preferred Generic	4	001000	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							27.00																9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	013	0	1	02	01	H8133_013_0	8	Preferred Generic	4	001000	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							27.00																9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8133	013	0	1	02	01	H8133_013_0	8	Generic	4	010010	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		60.00					9.00		27.00							60.00																20.00				20.00			0.67	0.30				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	013	0	1	02	01	H8133_013_0	8	Generic	4	010010	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								20.00		60.00					9.00		27.00							60.00																20.00				20.00			0.67	0.30				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8133	013	0	1	02	01	H8133_013_0	8	Preferred Brand	4	010001	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					39.00		117.00							141.00																47.00				47.00			1.57	1.30				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	013	0	1	02	01	H8133_013_0	8	Non-Preferred Brand	4	110000	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								100.00		300.00					95.00		285.00							300.00																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	013	0	1	02	01	H8133_013_0	8	Specialty Tier	4	010010	1	1	5	1		110	01	100		1				30		90	1	2			90				30		31											667.00	33		33				673.33	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	014	0	1	02	01	H8133_014_0	8	Preferred Generic	4	001000	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							27.00																9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	014	0	1	02	01	H8133_014_0	8	Preferred Generic	4	001000	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							27.00																9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8133	014	0	1	02	01	H8133_014_0	8	Generic	4	010010	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		60.00					9.00		27.00							60.00																20.00				20.00			0.67	0.30				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	014	0	1	02	01	H8133_014_0	8	Generic	4	010010	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								20.00		60.00					9.00		27.00							60.00																20.00				20.00			0.67	0.30				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8133	014	0	1	02	01	H8133_014_0	8	Preferred Brand	4	010001	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					39.00		117.00							141.00																47.00				47.00			1.57	1.30				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	014	0	1	02	01	H8133_014_0	8	Non-Preferred Brand	4	110000	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								100.00		300.00					95.00		285.00							300.00																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8133	014	0	1	02	01	H8133_014_0	8	Specialty Tier	4	010010	1	1	5	1		110	01	100		1				30		90	1	2			90				30		31											659.39	33		33				665.28	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8145	003	0	1	09	04	H8145_003_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	003	0	1	09	04	H8145_003_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	003	0	1	09	04	H8145_003_0	3	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	003	0	1	09	04	H8145_003_0	3	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	003	0	1	09	04	H8145_003_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	003	0	1	09	04	H8145_003_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	003	0	1	09	04	H8145_003_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	003	0	1	09	04	H8145_003_0	3	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	003	0	1	09	04	H8145_003_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	003	0	1	09	04	H8145_003_0	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	004	0	1	09	04	H8145_004_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	004	0	1	09	04	H8145_004_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	004	0	1	09	04	H8145_004_0	3	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	004	0	1	09	04	H8145_004_0	3	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	004	0	1	09	04	H8145_004_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	004	0	1	09	04	H8145_004_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	004	0	1	09	04	H8145_004_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	004	0	1	09	04	H8145_004_0	3	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	004	0	1	09	04	H8145_004_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	004	0	1	09	04	H8145_004_0	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	006	0	1	09	04	H8145_006_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	006	0	1	09	04	H8145_006_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	006	0	1	09	04	H8145_006_0	3	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	006	0	1	09	04	H8145_006_0	3	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	006	0	1	09	04	H8145_006_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	006	0	1	09	04	H8145_006_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	006	0	1	09	04	H8145_006_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	006	0	1	09	04	H8145_006_0	3	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	006	0	1	09	04	H8145_006_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	006	0	1	09	04	H8145_006_0	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	008	0	1	09	04	H8145_008_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	008	0	1	09	04	H8145_008_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	008	0	1	09	04	H8145_008_0	3	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	008	0	1	09	04	H8145_008_0	3	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	008	0	1	09	04	H8145_008_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	008	0	1	09	04	H8145_008_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	008	0	1	09	04	H8145_008_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	008	0	1	09	04	H8145_008_0	3	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	008	0	1	09	04	H8145_008_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	008	0	1	09	04	H8145_008_0	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	011	0	1	09	04	H8145_011_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	011	0	1	09	04	H8145_011_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	011	0	1	09	04	H8145_011_0	3	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	011	0	1	09	04	H8145_011_0	3	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	011	0	1	09	04	H8145_011_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	011	0	1	09	04	H8145_011_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	011	0	1	09	04	H8145_011_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	011	0	1	09	04	H8145_011_0	3	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	011	0	1	09	04	H8145_011_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	011	0	1	09	04	H8145_011_0	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	021	0	1	09	04	H8145_021_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	021	0	1	09	04	H8145_021_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	021	0	1	09	04	H8145_021_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	021	0	1	09	04	H8145_021_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	021	0	1	09	04	H8145_021_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	021	0	1	09	04	H8145_021_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	021	0	1	09	04	H8145_021_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	021	0	1	09	04	H8145_021_0	4	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	021	0	1	09	04	H8145_021_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	021	0	1	09	04	H8145_021_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	032	0	1	09	04	H8145_032_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	032	0	1	09	04	H8145_032_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	032	0	1	09	04	H8145_032_0	3	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	032	0	1	09	04	H8145_032_0	3	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	032	0	1	09	04	H8145_032_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	032	0	1	09	04	H8145_032_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	032	0	1	09	04	H8145_032_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	032	0	1	09	04	H8145_032_0	3	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	032	0	1	09	04	H8145_032_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	032	0	1	09	04	H8145_032_0	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	051	0	1	09	04	H8145_051_0	4	Preferred Generic	3	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								8.00		24.00					3.00		9.00											8.00		24.00				3.00		0.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	051	0	1	09	04	H8145_051_0	4	Generic	3	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								14.00		42.00					9.00		27.00											14.00		42.00				9.00		0.00				14.00				14.00			0.47	0.30		0.47	0.30	0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	051	0	1	09	04	H8145_051_0	4	Preferred Brand	3	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	051	0	1	09	04	H8145_051_0	4	Non-Preferred Drug	3	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	051	0	1	09	04	H8145_051_0	4	Specialty Tier	3	010010	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	052	0	1	09	04	H8145_052_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	052	0	1	09	04	H8145_052_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	052	0	1	09	04	H8145_052_0	3	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	052	0	1	09	04	H8145_052_0	3	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	052	0	1	09	04	H8145_052_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	052	0	1	09	04	H8145_052_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	052	0	1	09	04	H8145_052_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	052	0	1	09	04	H8145_052_0	3	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	052	0	1	09	04	H8145_052_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	052	0	1	09	04	H8145_052_0	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	053	0	1	09	04	H8145_053_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	053	0	1	09	04	H8145_053_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	053	0	1	09	04	H8145_053_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	053	0	1	09	04	H8145_053_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	053	0	1	09	04	H8145_053_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	053	0	1	09	04	H8145_053_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	053	0	1	09	04	H8145_053_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	053	0	1	09	04	H8145_053_0	4	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	053	0	1	09	04	H8145_053_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	053	0	1	09	04	H8145_053_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	061	0	1	09	04	H8145_061_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	061	0	1	09	04	H8145_061_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	061	0	1	09	04	H8145_061_0	3	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	061	0	1	09	04	H8145_061_0	3	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	061	0	1	09	04	H8145_061_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	061	0	1	09	04	H8145_061_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	061	0	1	09	04	H8145_061_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	061	0	1	09	04	H8145_061_0	3	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	061	0	1	09	04	H8145_061_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	061	0	1	09	04	H8145_061_0	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	063	0	1	09	04	H8145_063_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	063	0	1	09	04	H8145_063_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	063	0	1	09	04	H8145_063_0	3	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	063	0	1	09	04	H8145_063_0	3	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	063	0	1	09	04	H8145_063_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	063	0	1	09	04	H8145_063_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	063	0	1	09	04	H8145_063_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	063	0	1	09	04	H8145_063_0	3	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	063	0	1	09	04	H8145_063_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	063	0	1	09	04	H8145_063_0	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	069	0	1	09	04	H8145_069_0	4	Preferred Generic	3	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	069	0	1	09	04	H8145_069_0	4	Generic	3	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	069	0	1	09	04	H8145_069_0	4	Preferred Brand	3	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	069	0	1	09	04	H8145_069_0	4	Non-Preferred Drug	3	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	069	0	1	09	04	H8145_069_0	4	Specialty Tier	3	010010	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	075	0	1	09	04	H8145_075_0	4	Preferred Generic	3	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	075	0	1	09	04	H8145_075_0	4	Generic	3	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	075	0	1	09	04	H8145_075_0	4	Preferred Brand	3	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	075	0	1	09	04	H8145_075_0	4	Non-Preferred Drug	3	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	075	0	1	09	04	H8145_075_0	4	Specialty Tier	3	010010	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	084	0	1	09	04	H8145_084_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	084	0	1	09	04	H8145_084_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	084	0	1	09	04	H8145_084_0	3	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								17.00		51.00					12.00		36.00											17.00		51.00				12.00		0.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	084	0	1	09	04	H8145_084_0	3	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								17.00		51.00					12.00		36.00											17.00		51.00				12.00		0.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	084	0	1	09	04	H8145_084_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	084	0	1	09	04	H8145_084_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	084	0	1	09	04	H8145_084_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	084	0	1	09	04	H8145_084_0	3	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	084	0	1	09	04	H8145_084_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	084	0	1	09	04	H8145_084_0	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	087	0	1	09	04	H8145_087_0	3	Preferred Generic	3	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	087	0	1	09	04	H8145_087_0	3	Generic	3	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								15.00		45.00					10.00		30.00											15.00		45.00				10.00		0.00				15.00				15.00			0.50	0.33		0.50	0.33	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	087	0	1	09	04	H8145_087_0	3	Preferred Brand	3	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	087	0	1	09	04	H8145_087_0	3	Non-Preferred Drug	3	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	087	0	1	09	04	H8145_087_0	3	Specialty Tier	3	010010	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	089	0	1	09	04	H8145_089_0	3	Preferred Generic	3	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								8.00		24.00					3.00		9.00											8.00		24.00				3.00		0.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	089	0	1	09	04	H8145_089_0	3	Generic	3	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								16.00		48.00					11.00		33.00											16.00		48.00				11.00		0.00				16.00				16.00			0.53	0.37		0.53	0.37	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	089	0	1	09	04	H8145_089_0	3	Preferred Brand	3	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	089	0	1	09	04	H8145_089_0	3	Non-Preferred Drug	3	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	089	0	1	09	04	H8145_089_0	3	Specialty Tier	3	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	091	0	1	09	04	H8145_091_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	091	0	1	09	04	H8145_091_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	091	0	1	09	04	H8145_091_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	091	0	1	09	04	H8145_091_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	091	0	1	09	04	H8145_091_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	091	0	1	09	04	H8145_091_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	091	0	1	09	04	H8145_091_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	091	0	1	09	04	H8145_091_0	4	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	091	0	1	09	04	H8145_091_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	091	0	1	09	04	H8145_091_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	093	0	1	09	04	H8145_093_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								9.00		27.00					4.00		12.00											9.00		27.00				4.00		0.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	093	0	1	09	04	H8145_093_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								9.00		27.00					4.00		12.00											9.00		27.00				4.00		0.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	093	0	1	09	04	H8145_093_0	3	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	093	0	1	09	04	H8145_093_0	3	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	093	0	1	09	04	H8145_093_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	093	0	1	09	04	H8145_093_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	093	0	1	09	04	H8145_093_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	093	0	1	09	04	H8145_093_0	3	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	093	0	1	09	04	H8145_093_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	093	0	1	09	04	H8145_093_0	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	103	0	1	09	04	H8145_103_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	103	0	1	09	04	H8145_103_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	103	0	1	09	04	H8145_103_0	3	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	103	0	1	09	04	H8145_103_0	3	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	103	0	1	09	04	H8145_103_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	103	0	1	09	04	H8145_103_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	103	0	1	09	04	H8145_103_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	103	0	1	09	04	H8145_103_0	3	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	103	0	1	09	04	H8145_103_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	103	0	1	09	04	H8145_103_0	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	122	0	1	09	04	H8145_122_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					8.00		24.00											10.00		30.00				8.00		0.00				10.00				10.00			0.33	0.27		0.33	0.27	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	122	0	1	09	04	H8145_122_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					8.00		24.00											10.00		30.00				8.00		0.00				10.00				10.00			0.33	0.27		0.33	0.27	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	122	0	1	09	04	H8145_122_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	122	0	1	09	04	H8145_122_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	122	0	1	09	04	H8145_122_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	122	0	1	09	04	H8145_122_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	122	0	1	09	04	H8145_122_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	122	0	1	09	04	H8145_122_0	4	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	122	0	1	09	04	H8145_122_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	122	0	1	09	04	H8145_122_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	123	0	1	09	04	H8145_123_0	12	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	123	0	1	09	04	H8145_123_0	12	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	123	0	1	09	04	H8145_123_0	12	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	123	0	1	09	04	H8145_123_0	12	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	123	0	1	09	04	H8145_123_0	12	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	123	0	1	09	04	H8145_123_0	12	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	123	0	1	09	04	H8145_123_0	12	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	123	0	1	09	04	H8145_123_0	12	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	123	0	1	09	04	H8145_123_0	12	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	123	0	1	09	04	H8145_123_0	12	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												27							27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	125	0	1	09	04	H8145_125_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					8.00		24.00											10.00		30.00				8.00		0.00				10.00				10.00			0.33	0.27		0.33	0.27	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	125	0	1	09	04	H8145_125_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					8.00		24.00											10.00		30.00				8.00		0.00				10.00				10.00			0.33	0.27		0.33	0.27	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	125	0	1	09	04	H8145_125_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	125	0	1	09	04	H8145_125_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	125	0	1	09	04	H8145_125_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	125	0	1	09	04	H8145_125_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	125	0	1	09	04	H8145_125_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	125	0	1	09	04	H8145_125_0	4	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8145	125	0	1	09	04	H8145_125_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8145	125	0	1	09	04	H8145_125_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8146	003	0	1	01	01	H8146_003_0	9	Preferred Generic	4	001000	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8146	003	0	1	01	01	H8146_003_0	9	Preferred Generic	4	001000	1	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8146	003	0	1	01	01	H8146_003_0	9	Generic	4	010000	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					14	31	12.00	24.00	30.00																			12.00	24.00	30.00																	12.00			12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8146	003	0	1	01	01	H8146_003_0	9	Preferred Brand	4	010001	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					14	31	45.00	90.00	112.50																			45.00	90.00	112.50																	45.00			45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8146	003	0	1	01	01	H8146_003_0	9	Non-Preferred Drug	4	110000	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					14	31	90.00	180.00	225.00																			90.00	180.00	225.00																	90.00			90.00		3.00			3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8146	003	0	1	01	01	H8146_003_0	9	Specialty Tier	4	010010	1	1	5	1	111		10	111		1	30	60	90				2	2	30	60	90					14	31					33	33	33																		33	33	33																33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8146	005	0	1	01	01	H8146_005_0	8	Preferred Generic	4	001000	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8146	005	0	1	01	01	H8146_005_0	8	Preferred Generic	4	001000	1	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8146	005	0	1	01	01	H8146_005_0	8	Generic	4	010000	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					14	31	12.00	24.00	30.00																			12.00	24.00	30.00																	12.00			12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8146	005	0	1	01	01	H8146_005_0	8	Preferred Brand	4	010001	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					14	31	45.00	90.00	112.50																			45.00	90.00	112.50																	45.00			45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8146	005	0	1	01	01	H8146_005_0	8	Non-Preferred Drug	4	110000	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					14	31	90.00	180.00	225.00																			90.00	180.00	225.00																	90.00			90.00		3.00			3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8146	005	0	1	01	01	H8146_005_0	8	Specialty Tier	4	010010	1	1	5	1	111		10	111		1	30	60	90				2	2	30	60	90					14	31					33	33	33																		33	33	33																33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8146	008	0	1	01	01	H8146_008_0	9	Preferred Generic	4	001000	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8146	008	0	1	01	01	H8146_008_0	9	Preferred Generic	4	001000	1	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8146	008	0	1	01	01	H8146_008_0	9	Generic	4	010000	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					14	31	12.00	24.00	30.00																			12.00	24.00	30.00																	12.00			12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8146	008	0	1	01	01	H8146_008_0	9	Preferred Brand	4	010001	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					14	31	45.00	90.00	112.50																			45.00	90.00	112.50																	45.00			45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8146	008	0	1	01	01	H8146_008_0	9	Non-Preferred Drug	4	110000	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					14	31	90.00	180.00	225.00																			90.00	180.00	225.00																	90.00			90.00		3.00			3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8146	008	0	1	01	01	H8146_008_0	9	Specialty Tier	4	010010	1	1	5	1	111		10	111		1	30	60	90				2	2	30	60	90					14	31					33	33	33																		33	33	33																33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8146	009	0	1	01	01	H8146_009_0	10	Preferred Generic	4	001000	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8146	009	0	1	01	01	H8146_009_0	10	Preferred Generic	4	001000	1	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8146	009	0	1	01	01	H8146_009_0	10	Generic	4	010000	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					14	31	12.00	24.00	30.00																			12.00	24.00	30.00																	12.00			12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8146	009	0	1	01	01	H8146_009_0	10	Preferred Brand	4	010001	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					14	31	45.00	90.00	112.50																			45.00	90.00	112.50																	45.00			45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8146	009	0	1	01	01	H8146_009_0	10	Non-Preferred Drug	4	110000	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					14	31	90.00	180.00	225.00																			90.00	180.00	225.00																	90.00			90.00		3.00			3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8146	009	0	1	01	01	H8146_009_0	10	Specialty Tier	4	010010	1	1	5	1	111		10	111		1	30	60	90				2	2	30	60	90					14	31					33	33	33																		33	33	33																33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8146	010	0	1	01	01	H8146_010_0	11	Preferred Generic	4	001000	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8146	010	0	1	01	01	H8146_010_0	11	Preferred Generic	4	001000	1	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8146	010	0	1	01	01	H8146_010_0	11	Generic	4	010000	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					14	31	12.00	24.00	30.00																			12.00	24.00	30.00																	12.00			12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8146	010	0	1	01	01	H8146_010_0	11	Preferred Brand	4	010001	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					14	31	45.00	90.00	112.50																			45.00	90.00	112.50																	45.00			45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8146	010	0	1	01	01	H8146_010_0	11	Non-Preferred Drug	4	110000	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					14	31	90.00	180.00	225.00																			90.00	180.00	225.00																	90.00			90.00		3.00			3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8146	010	0	1	01	01	H8146_010_0	11	Specialty Tier	4	010010	1	1	5	1	111		10	111		1	30	60	90				2	2	30	60	90					14	31					33	33	33																		33	33	33																33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8146	011	0	1	01	01	H8146_011_0	10	Preferred Generic	4	001000	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8146	011	0	1	01	01	H8146_011_0	10	Preferred Generic	4	001000	1	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8146	011	0	1	01	01	H8146_011_0	10	Generic	4	010000	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					14	31	12.00	24.00	30.00																			12.00	24.00	30.00																	12.00			12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8146	011	0	1	01	01	H8146_011_0	10	Preferred Brand	4	010001	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					14	31	45.00	90.00	112.50																			45.00	90.00	112.50																	45.00			45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8146	011	0	1	01	01	H8146_011_0	10	Non-Preferred Drug	4	110000	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					14	31	90.00	180.00	225.00																			90.00	180.00	225.00																	90.00			90.00		3.00			3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8146	011	0	1	01	01	H8146_011_0	10	Specialty Tier	4	010010	1	1	5	1	111		10	111		1	30	60	90				2	2	30	60	90					14	31					33	33	33																		33	33	33																33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8146	012	0	1	01	01	H8146_012_0	8	Preferred Generic	4	001000	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8146	012	0	1	01	01	H8146_012_0	8	Preferred Generic	4	001000	1	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8146	012	0	1	01	01	H8146_012_0	8	Generic	4	010000	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					14	31	12.00	24.00	30.00																			12.00	24.00	30.00																	12.00			12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8146	012	0	1	01	01	H8146_012_0	8	Preferred Brand	4	010001	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					14	31	45.00	90.00	112.50																			45.00	90.00	112.50																	45.00			45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8146	012	0	1	01	01	H8146_012_0	8	Non-Preferred Drug	4	110000	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					14	31	90.00	180.00	225.00																			90.00	180.00	225.00																	90.00			90.00		3.00			3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8146	012	0	1	01	01	H8146_012_0	8	Specialty Tier	4	010010	1	1	5	1	111		10	111		1	30	60	90				2	2	30	60	90					14	31					33	33	33																		33	33	33																33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8146	013	0	1	01	01	H8146_013_0	10	Preferred Generic	4	001000	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8146	013	0	1	01	01	H8146_013_0	10	Preferred Generic	4	001000	1	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8146	013	0	1	01	01	H8146_013_0	10	Generic	4	010000	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					14	31	12.00	24.00	30.00																			12.00	24.00	30.00																	12.00			12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8146	013	0	1	01	01	H8146_013_0	10	Preferred Brand	4	010001	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					14	31	45.00	90.00	112.50																			45.00	90.00	112.50																	45.00			45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8146	013	0	1	01	01	H8146_013_0	10	Non-Preferred Drug	4	110000	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					14	31	90.00	180.00	225.00																			90.00	180.00	225.00																	90.00			90.00		3.00			3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8146	013	0	1	01	01	H8146_013_0	10	Specialty Tier	4	010010	1	1	5	1	111		10	111		1	30	60	90				2	2	30	60	90					14	31					33	33	33																		33	33	33																33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8146	014	0	1	01	01	H8146_014_0	8	Preferred Generic	4	001000	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8146	014	0	1	01	01	H8146_014_0	8	Preferred Generic	4	001000	1	2	1	3	111		10	111		1	30	60	90				1	2	30	60	90					14	31	3.00	6.00	7.50																			3.00	6.00	7.50																	3.00			3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8146	014	0	1	01	01	H8146_014_0	8	Generic	4	010000	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					14	31	12.00	24.00	30.00																			12.00	24.00	30.00																	12.00			12.00		0.40			0.40			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8146	014	0	1	01	01	H8146_014_0	8	Preferred Brand	4	010001	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					14	31	45.00	90.00	112.50																			45.00	90.00	112.50																	45.00			45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8146	014	0	1	01	01	H8146_014_0	8	Non-Preferred Drug	4	110000	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					14	31	90.00	180.00	225.00																			90.00	180.00	225.00																	90.00			90.00		3.00			3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8146	014	0	1	01	01	H8146_014_0	8	Specialty Tier	4	010010	1	1	5	1	111		10	111		1	30	60	90				2	2	30	60	90					14	31					33	33	33																		33	33	33																33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8170	001	0	1	01	01	H8170_001_0	6	Preferred Generic	4	001000	3	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8170	001	0	1	01	01	H8170_001_0	6	Preferred Brand	4	000101	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	45.00		135.00																			45.00		112.50																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8170	001	0	1	01	01	H8170_001_0	6	Non-Preferred Drug	4	100100	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	95.00		285.00																			95.00		237.50																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8170	001	0	1	01	01	H8170_001_0	6	Specialty Tier	4	100100	1	1	4	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8170	002	0	1	01	01	H8170_002_0	5	Preferred Generic	4	001000	3	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	0.00		0.00																			0.00		0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8170	002	0	1	01	01	H8170_002_0	5	Preferred Brand	4	000101	1	2	2	1	110		01	110		1	30		90				2	2	30		90				30		31	45.00		135.00																			45.00		112.50																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8170	002	0	1	01	01	H8170_002_0	5	Non-Preferred Drug	4	100100	3	2	3	1	110		01	110		1	30		90				2	2	30		90				30		31	95.00		285.00																			95.00		237.50																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8170	002	0	1	01	01	H8170_002_0	5	Specialty Tier	4	100100	1	1	4	1	010		01	010		1	30								30						30		31					33																				33																	33			33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8189	001	0	1	01	01	H8189_001_0	10	Preferred Generic	3	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8189	001	0	1	01	01	H8189_001_0	10	Generic	3	010000	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 Brand, Specialty Tier												
H8189	001	0	1	01	01	H8189_001_0	10	Preferred Brand	3	000001	1	2	3	1	111		01	111		1	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												
H8189	001	0	1	01	01	H8189_001_0	10	Non-Preferred Brand	3	100000	1	2	4	1	111		01	111		1	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												
H8189	001	0	1	01	01	H8189_001_0	10	Specialty Tier	3	010010	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												
H8197	001	0	1	48	05	H8197_001_0	5	Generic Drugs	4	010000			1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8197	001	0	1	48	05	H8197_001_0	5	Brand Drugs	4	010010			2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8197	001	0	1	48	05	H8197_001_0	5	Non-Medicare Rx/OTC Drugs	4	010010			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			
H8213	001	0	1	48	05	H8213_001_0	4	Generic Drugs	4	010000			1	1	110		01	100		1	30		90				1	2			90				30		31																																														0.00						0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8213	001	0	1	48	05	H8213_001_0	4	Brand Drugs	4	000010			2	1	110		01	100		1	30		90				1	2			90				30		31																																														0.00						0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8213	001	0	1	48	05	H8213_001_0	4	Non-Medicare Rx/OTC Drugs	4	000010			3	1	110		01	100		1	30		90				1	2			90				30		31																																														0.00						0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8237	001	0	1	01	01	H8237_001_0	11	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8237	001	0	1	01	01	H8237_001_0	11	Generic	4	010000	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 Drug, Specialty Tier												
H8237	001	0	1	01	01	H8237_001_0	11	Preferred Brand	4	000001	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 Drug, Specialty Tier												
H8237	001	0	1	01	01	H8237_001_0	11	Non-Preferred Drug	4	100100	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8237	001	0	1	01	01	H8237_001_0	11	Specialty Tier	4	010010	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												
H8237	003	0	1	02	01	H8237_003_0	11	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	2.00	4.00	6.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8237	003	0	1	02	01	H8237_003_0	11	Generic	4	010000	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 Drug, Specialty Tier												
H8237	003	0	1	02	01	H8237_003_0	11	Preferred Brand	4	000001	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 Drug, Specialty Tier												
H8237	003	0	1	02	01	H8237_003_0	11	Non-Preferred Drug	4	100100	1	2	4	1	111		01	111		1	30	60	90				2	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	190.00																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8237	003	0	1	02	01	H8237_003_0	11	Specialty Tier	4	010010	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												
H8258	001	0	1	48	05	H8258_001_0	7	Generic Drugs	4	010000			1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31																																														0.00			0.00			0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8258	001	0	1	48	05	H8258_001_0	7	Brand Drugs	4	000010			2	1	111		10	111		1	30	60	90				2	2	30	60	90					10	31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	0.00	8.25			0.00	8.25	0.00	8.25			
H8258	001	0	1	48	05	H8258_001_0	7	Non-Medicare Rx Drugs	4	010010			3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31																																														0.00			0.00			0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8258	001	0	1	48	05	H8258_001_0	7	Non-Medicare OTC Drugs	4	010010			4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31																																														0.00			0.00			0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8266	001	0	1	01	01	H8266_001_0	17	Generic	4	010000	1	2	1	1	111		01	100		1	30	60	90				2	1			90				30		31	5.00	10.00	15.00																					15.00																5.00				5.00		0.17						0.16	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8266	001	0	1	01	01	H8266_001_0	17	Generic	4	010000	1	2	1	3	111		01	100		1	30	60	90				2	1			90				30		31	5.00	10.00	15.00																					15.00																5.00				5.00		0.17						0.16	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8266	001	0	1	01	01	H8266_001_0	17	Preferred Brand	4	000001	1	2	2	1	111		01	100		1	30	60	90				2	1			90				30		31	40.00	80.00	120.00																					120.00																40.00				40.00		1.33						1.29	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8266	001	0	1	01	01	H8266_001_0	17	Non-Preferred Brand	4	100000	3	2	3	1	111		01	100		1	30	60	90				2	1			90				30		31	75.00	150.00	225.00																					225.00																75.00				75.00		2.50						2.42	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8266	001	0	1	01	01	H8266_001_0	17	Specialty Tier	4	010010	1	1	4	1	111		01	100		1	30	60	90				2	1			90				30		31				1123.34	33	33	33																				33															33			33								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8266	002	0	1	01	01	H8266_002_0	17	Generic	4	010000	1	2	1	1	111		01	100		1	30	60	90				2	1			90				30		31	5.00	10.00	15.00																					15.00																5.00				5.00		0.17						0.16	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8266	002	0	1	01	01	H8266_002_0	17	Generic	4	010000	1	2	1	3	111		01	100		1	30	60	90				2	1			90				30		31	5.00	10.00	15.00																					15.00																5.00				5.00		0.17						0.16	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8266	002	0	1	01	01	H8266_002_0	17	Preferred Brand	4	000001	1	2	2	1	111		01	100		1	30	60	90				2	1			90				30		31	25.00	50.00	75.00																					75.00																25.00				25.00		0.83						0.81	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8266	002	0	1	01	01	H8266_002_0	17	Non-Preferred Brand	4	100000	3	2	3	1	111		01	100		1	30	60	90				2	1			90				30		31	45.00	90.00	135.00																					135.00																45.00				45.00		1.50						1.45	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8266	002	0	1	01	01	H8266_002_0	17	Specialty Tier	4	010010	1	1	4	1	111		01	100		1	30	60	90				2	1			90				30		31				1540.11	33	33	33																				33															33			33								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8266	004	0	1	01	01	H8266_004_0	19	Generic	4	010000	1	2	1	1	111		01	100		1	30	60	90				2	1			90				30		31	5.00	10.00	15.00																					15.00																5.00				5.00		0.17						0.16	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8266	004	0	1	01	01	H8266_004_0	19	Generic	4	010000	1	2	1	3	111		01	100		1	30	60	90				2	1			90				30		31	5.00	10.00	15.00																					15.00																5.00				5.00		0.17						0.16	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8266	004	0	1	01	01	H8266_004_0	19	Preferred Brand	4	000001	1	2	2	1	111		01	100		1	30	60	90				2	1			90				30		31	40.00	80.00	120.00																					120.00																40.00				40.00		1.33						1.29	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8266	004	0	1	01	01	H8266_004_0	19	Non-Preferred Brand	4	100000	1	2	3	1	111		01	100		1	30	60	90				2	1			90				30		31	75.00	150.00	225.00																					225.00																75.00				75.00		2.50						2.42	Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8266	004	0	1	01	01	H8266_004_0	19	Specialty Tier	4	010010	1	1	4	1	111		01	100		1	30	60	90				2	1			90				30		31				1123.34	33	33	33																				33															33			33								Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8289	001	0	1	01	01	H8289_001_0	3	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	9.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8289	001	0	1	01	01	H8289_001_0	3	Preferred Generic	4	001000	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	9.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H8289	001	0	1	01	01	H8289_001_0	3	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	45.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8289	001	0	1	01	01	H8289_001_0	3	Preferred Brand	4	010001	1	2	3	1	111		01	111		1	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, Select Care Drugs												
H8289	001	0	1	01	01	H8289_001_0	3	Non-Preferred Brand	4	110000	1	2	4	1	111		01	111		1	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, Select Care Drugs												
H8289	001	0	1	01	01	H8289_001_0	3	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31					30																				30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8289	001	0	1	01	01	H8289_001_0	3	Select Care Drugs	4	010000	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8289	001	0	1	01	01	H8289_001_0	3	Select Care Drugs	4	010000	1	2	6	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H8289	002	0	1	01	01	H8289_002_0	3	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	9.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8289	002	0	1	01	01	H8289_002_0	3	Preferred Generic	4	001000	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	9.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H8289	002	0	1	01	01	H8289_002_0	3	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	45.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8289	002	0	1	01	01	H8289_002_0	3	Preferred Brand	4	010001	1	2	3	1	111		01	111		1	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, Select Care Drugs												
H8289	002	0	1	01	01	H8289_002_0	3	Non-Preferred Brand	4	110000	1	2	4	1	111		01	111		1	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, Select Care Drugs												
H8289	002	0	1	01	01	H8289_002_0	3	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31					30																				30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8289	002	0	1	01	01	H8289_002_0	3	Select Care Drugs	4	010000	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H8289	002	0	1	01	01	H8289_002_0	3	Select Care Drugs	4	010000	1	2	6	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H8423	001	0	1	48	05	H8423_001_0	5	Generic Drugs	4	010000			1	1	111		01	110		1	30	60	90				2	2	30		90				30		31																																																					Generic Drugs, Brand Drugs	3	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8423	001	0	1	48	05	H8423_001_0	5	Brand Drugs	4	000010			2	1	111		01	110		1	30	60	90				2	2	30		90				30		31																																																					Generic Drugs, Brand Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8432	002	0	1	01	01	H8432_002_0	7	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	002	0	1	01	01	H8432_002_0	7	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								13.00	26.00	39.00					13.00	26.00	39.00					13.00	39.00	39.00																13.00				13.00			0.43	0.43	0.43			0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	002	0	1	01	01	H8432_002_0	7	Preferred Brand	4	000101	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												
H8432	002	0	1	01	01	H8432_002_0	7	Non-Preferred Drug	4	100100	1	2	4	1		111	01	111		1				30	60	90	1	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	002	0	1	01	01	H8432_002_0	7	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	002	0	1	01	01	H8432_002_0	7	Select Care Drugs	4	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	002	0	1	01	01	H8432_002_0	7	Select Care Drugs	4	001000	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8432	003	0	1	01	01	H8432_003_0	6	Preferred Generic	4	001000	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	003	0	1	01	01	H8432_003_0	6	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								12.00	24.00	36.00					7.00	14.00	21.00					7.00	21.00	21.00																12.00				12.00			0.40	0.23	0.23			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	003	0	1	01	01	H8432_003_0	6	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	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	003	0	1	01	01	H8432_003_0	6	Non-Preferred Drug	4	100100	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												
H8432	003	0	1	01	01	H8432_003_0	6	Specialty Tier	4	010010	1	1	5	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	003	0	1	01	01	H8432_003_0	6	Select Care Drugs	4	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	003	0	1	01	01	H8432_003_0	6	Select Care Drugs	4	001000	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H8432	004	0	1	01	01	H8432_004_0	7	Preferred Generic	4	001000	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												
H8432	004	0	1	01	01	H8432_004_0	7	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	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	004	0	1	01	01	H8432_004_0	7	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	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	004	0	1	01	01	H8432_004_0	7	Non-Preferred Drug	4	100100	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												
H8432	004	0	1	01	01	H8432_004_0	7	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	004	0	1	01	01	H8432_004_0	7	Select Care Drugs	4	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8432	004	0	1	01	01	H8432_004_0	7	Select Care Drugs	4	001000	1	2	6	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		
H8452	001	0	1	48	05	H8452_001_0	5	Generic Drugs	4	010010			1	1	110		01	100		1	30		90				1	2			90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8452	001	0	1	48	05	H8452_001_0	5	Brand Drugs	4	010010			2	1	110		01	100		1	30		90				1	2			90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8452	001	0	1	48	05	H8452_001_0	5	Non-Medicare Rx/OTC Drugs	4	010010			3	1	110		01	100		1	30		90				1	2			90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8490	001	0	1	48	05	H8490_001_0	4	Generic Drugs	4	010000			1	1	111		01	100		1	30	60	90				1	2			90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8490	001	0	1	48	05	H8490_001_0	4	Brand Drugs	4	000010			2	1	111		01	100		1	30	60	90				1	2			90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8490	001	0	1	48	05	H8490_001_0	4	Non-Medicare Rx Drugs	4	010010			3	1	111		01	100		1	30	60	90				1	2			90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8490	001	0	1	48	05	H8490_001_0	4	Non-Medicare OTC Drugs	4	010010			4	1	111		01	100		1	30	60	90				1	2			90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8506	001	0	1	02	01	H8506_001_0	5	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	31	62	93				1	2	31	62	93				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 Brand, Specialty Tier												
H8506	001	0	1	02	01	H8506_001_0	5	Generic	4	010000	1	2	2	1	111		01	111		1	31	62	93				1	2	31	62	93				31		31	10.00	20.00	30.00																			10.00	20.00	30.00																10.00				10.00		0.32			0.32			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8506	001	0	1	02	01	H8506_001_0	5	Preferred Brand	4	000001	1	2	3	1	111		01	111		1	31	62	93				1	2	31	62	93				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 Brand, Specialty Tier												
H8506	001	0	1	02	01	H8506_001_0	5	Non-Preferred Brand	4	100000	1	2	4	1	111		01	111		1	31	62	93				1	2	31	62	93				31		31	95.00	190.00	285.00																			95.00	190.00	285.00																95.00				95.00		3.06			3.06			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8506	001	0	1	02	01	H8506_001_0	5	Specialty Tier	4	100100	1	1	5	1	010		01	010		1	31								31						31		31				300.00	30																				30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8552	020	0	1	04	01	H8552_020_0	8	Preferred Generic	3	001000	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												
H8552	020	0	1	04	01	H8552_020_0	8	Generic	3	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8552	020	0	1	04	01	H8552_020_0	8	Preferred Brand	3	000101	1	2	3	1		111	01	111		1				30	60	90	1	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	8	Non-Preferred Drug	3	100100	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												
H8552	020	0	1	04	01	H8552_020_0	8	Specialty Tier	3	010010	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												
H8552	020	0	1	04	01	H8552_020_0	8	Select Care Drugs	3	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8552	021	0	1	04	01	H8552_021_0	8	Preferred Generic	3	001000	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												
H8552	021	0	1	04	01	H8552_021_0	8	Generic	3	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8552	021	0	1	04	01	H8552_021_0	8	Preferred Brand	3	000101	1	2	3	1		111	01	111		1				30	60	90	1	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	021	0	1	04	01	H8552_021_0	8	Non-Preferred Drug	3	100100	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												
H8552	021	0	1	04	01	H8552_021_0	8	Specialty Tier	3	010010	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												
H8552	021	0	1	04	01	H8552_021_0	8	Select Care Drugs	3	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8552	028	0	1	04	01	H8552_028_0	8	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								19.00	38.00	57.00					14.00	28.00	42.00					14.00	42.00	42.00																19.00				19.00			0.63	0.47	0.47			0.56	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8552	028	0	1	04	01	H8552_028_0	8	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	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												
H8552	028	0	1	04	01	H8552_028_0	8	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	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	8	Non-Preferred Drug	4	100100	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												
H8552	028	0	1	04	01	H8552_028_0	8	Specialty Tier	4	010010	1	1	5	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	028	0	1	04	01	H8552_028_0	8	Select Care Drugs	4	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H8554	001	0	1	01	01	H8554_001_0	12	Preferred Generic	4	001000	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	5.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8554	001	0	1	01	01	H8554_001_0	12	Generic	4	010000	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 Brand, Specialty Tier												
H8554	001	0	1	01	01	H8554_001_0	12	Preferred Brand	4	000001	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	112.50																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8554	001	0	1	01	01	H8554_001_0	12	Non-Preferred Brand	4	100000	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	237.50																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8554	001	0	1	01	01	H8554_001_0	12	Specialty Tier	4	110001	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												
H8554	002	0	1	01	01	H8554_002_0	12	Preferred Generic	4	001000	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	5.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8554	002	0	1	01	01	H8554_002_0	12	Preferred Generic	4	001000	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	5.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8554	002	0	1	01	01	H8554_002_0	12	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	10.00	20.00	30.00																			10.00	20.00	25.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8554	002	0	1	01	01	H8554_002_0	12	Preferred Brand	4	000001	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	75.00																30.00				30.00		1.00			1.00			0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8554	002	0	1	01	01	H8554_002_0	12	Non-Preferred Brand	4	100000	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	95.00	190.00	285.00																			95.00	190.00	237.50																95.00				95.00		3.17			3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8554	002	0	1	01	01	H8554_002_0	12	Specialty Tier	4	110001	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												
H8578	001	0	1	01	01	H8578_001_0	4	Preferred Generic	4	001000	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	4.00	8.00	12.00																					8.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8578	001	0	1	01	01	H8578_001_0	4	Preferred Generic	4	001000	1	2	1	3	111		01	100		1	30	60	90				1	2			90				30		31	4.00	8.00	12.00																					8.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8578	001	0	1	01	01	H8578_001_0	4	Generic	4	010000	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8578	001	0	1	01	01	H8578_001_0	4	Preferred Brand	4	000001	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	45.00	90.00	135.00																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8578	001	0	1	01	01	H8578_001_0	4	Non-Preferred Brand	4	100000	3	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	95.00	190.00	285.00																					285.00																95.00				95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8578	001	0	1	01	01	H8578_001_0	4	Specialty Tier	4	100001	1	1	5	1	010		01			1	30														30		31				1.00	28																																					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8578	004	0	1	01	01	H8578_004_0	4	Preferred Generic	4	001000	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	4.00	8.00	12.00																					8.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8578	004	0	1	01	01	H8578_004_0	4	Generic	4	010000	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8578	004	0	1	01	01	H8578_004_0	4	Preferred Brand	4	000001	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	45.00	90.00	135.00																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8578	004	0	1	01	01	H8578_004_0	4	Non-Preferred Brand	4	100000	3	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	95.00	190.00	285.00																					285.00																95.00				95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8578	004	0	1	01	01	H8578_004_0	4	Specialty Tier	4	100001	1	1	5	1	010		01			1	30														30		31				1.00	28																																					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8578	012	0	1	01	01	H8578_012_0	4	Preferred Generic	4	001000	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	4.00	8.00	12.00																					8.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8578	012	0	1	01	01	H8578_012_0	4	Generic	4	010000	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8578	012	0	1	01	01	H8578_012_0	4	Preferred Brand	4	000001	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	45.00	90.00	135.00																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8578	012	0	1	01	01	H8578_012_0	4	Non-Preferred Brand	4	100000	3	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	95.00	190.00	285.00																					285.00																95.00				95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8578	012	0	1	01	01	H8578_012_0	4	Specialty Tier	4	100001	1	1	5	1	010		01			1	30														30		31				1.00	26																																					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8578	013	0	1	01	01	H8578_013_0	4	Preferred Generic	4	001000	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	4.00	8.00	12.00																					8.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8578	013	0	1	01	01	H8578_013_0	4	Generic	4	010000	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8578	013	0	1	01	01	H8578_013_0	4	Preferred Brand	4	000001	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	45.00	90.00	135.00																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8578	013	0	1	01	01	H8578_013_0	4	Non-Preferred Brand	4	100000	3	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	95.00	190.00	285.00																					285.00																95.00				95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8578	013	0	1	01	01	H8578_013_0	4	Specialty Tier	4	100001	1	1	5	1	010		01			1	30														30		31				1.00	28																																					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8578	014	0	1	01	01	H8578_014_0	4	Preferred Generic	4	001000	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	4.00	8.00	12.00																					8.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8578	014	0	1	01	01	H8578_014_0	4	Preferred Generic	4	001000	1	2	1	3	111		01	100		1	30	60	90				1	2			90				30		31	4.00	8.00	12.00																					8.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8578	014	0	1	01	01	H8578_014_0	4	Generic	4	010000	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8578	014	0	1	01	01	H8578_014_0	4	Generic	4	010000	1	2	2	3	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8578	014	0	1	01	01	H8578_014_0	4	Preferred Brand	4	000001	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	45.00	90.00	135.00																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8578	014	0	1	01	01	H8578_014_0	4	Non-Preferred Brand	4	100000	3	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	95.00	190.00	285.00																					285.00																95.00				95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8578	014	0	1	01	01	H8578_014_0	4	Specialty Tier	4	100001	1	1	5	1	010		01			1	30														30		31				1.00	28																																					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8578	015	0	1	02	01	H8578_015_0	5	Preferred Generic	4	001000	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	4.00	8.00	12.00																					8.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8578	015	0	1	02	01	H8578_015_0	5	Generic	4	010000	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	10.00	20.00	30.00																					20.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8578	015	0	1	02	01	H8578_015_0	5	Preferred Brand	4	000001	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	45.00	90.00	135.00																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8578	015	0	1	02	01	H8578_015_0	5	Non-Preferred Brand	4	100000	3	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	95.00	190.00	285.00																					285.00																95.00				95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8578	015	0	1	02	01	H8578_015_0	5	Specialty Tier	4	100001	1	1	5	1	010		01			1	30														30		31				1.00	28																																					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8604	010	0	1	04	01	H8604_010_0	6	Preferred Generic	4	001000	1	2	1	1		110	01	100		1				30		90	1	1			90				30		31								13.00		39.00					3.00		9.00							0.00																13.00				13.00			0.43	0.10				0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8604	010	0	1	04	01	H8604_010_0	6	Generic	4	010000	1	2	2	1		110	01	100		1				30		90	1	1			90				30		31								20.00		60.00					10.00		30.00							20.00																20.00				20.00			0.67	0.33				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8604	010	0	1	04	01	H8604_010_0	6	Preferred Brand	4	000001	1	2	3	1		110	01	100		1				30		90	1	1			90				30		31								45.00		135.00					35.00		105.00							70.00																45.00				45.00			1.50	1.17				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8604	010	0	1	04	01	H8604_010_0	6	Non-Preferred Drug	4	100000	1	2	4	1		110	01	100		1				30		90	1	1			90				30		31								95.00		285.00					85.00		255.00							170.00																95.00				95.00			3.17	2.83				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8604	010	0	1	04	01	H8604_010_0	6	Specialty Tier	4	000010	1	1	5	1		010	01	010		1				30					30						30		31											1000.00	31						1000.00	31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8604	011	0	1	04	01	H8604_011_0	10	Preferred Generic	4	001000	1	2	1	1		110	01	100		1				30		90	1	1			90				30		31								13.00		39.00					3.00		9.00							0.00																13.00				13.00			0.43	0.10				0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8604	011	0	1	04	01	H8604_011_0	10	Generic	4	010000	1	2	2	1		110	01	100		1				30		90	1	1			90				30		31								20.00		60.00					10.00		30.00							20.00																20.00				20.00			0.67	0.33				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8604	011	0	1	04	01	H8604_011_0	10	Preferred Brand	4	000001	1	2	3	1		110	01	100		1				30		90	1	1			90				30		31								45.00		135.00					35.00		105.00							70.00																45.00				45.00			1.50	1.17				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8604	011	0	1	04	01	H8604_011_0	10	Non-Preferred Drug	4	100000	1	2	4	1		110	01	100		1				30		90	1	1			90				30		31								95.00		285.00					85.00		255.00							170.00																95.00				95.00			3.17	2.83				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8604	011	0	1	04	01	H8604_011_0	10	Specialty Tier	4	000010	1	1	5	1		010	01	010		1				30					30						30		31											1000.00	31						1000.00	31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8604	013	0	1	04	01	H8604_013_0	8	Preferred Generic	4	001000	1	2	1	1		110	01	100		1				30		90	1	1			90				30		31								13.00		39.00					3.00		9.00							0.00																13.00				13.00			0.43	0.10				0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8604	013	0	1	04	01	H8604_013_0	8	Generic	4	010000	1	2	2	1		110	01	100		1				30		90	1	1			90				30		31								20.00		60.00					10.00		30.00							20.00																20.00				20.00			0.67	0.33				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8604	013	0	1	04	01	H8604_013_0	8	Preferred Brand	4	000001	1	2	3	1		110	01	100		1				30		90	1	1			90				30		31								45.00		135.00					35.00		105.00							70.00																45.00				45.00			1.50	1.17				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8604	013	0	1	04	01	H8604_013_0	8	Non-Preferred Drug	4	100000	1	2	4	1		110	01	100		1				30		90	1	1			90				30		31								95.00		285.00					85.00		255.00							170.00																95.00				95.00			3.17	2.83				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8604	013	0	1	04	01	H8604_013_0	8	Specialty Tier	4	000010	1	1	5	1		010	01	010		1				30					30						30		31											1000.00	31						1000.00	31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8634	001	0	1	04	01	H8634_001_0	6	Preferred Generic	4	001000	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							27.00																9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8634	001	0	1	04	01	H8634_001_0	6	Preferred Generic	4	001000	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							27.00																9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8634	001	0	1	04	01	H8634_001_0	6	Generic	4	010010	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								15.00		45.00					6.00		18.00							45.00																15.00				15.00			0.50	0.20				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8634	001	0	1	04	01	H8634_001_0	6	Generic	4	010010	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								15.00		45.00					6.00		18.00							45.00																15.00				15.00			0.50	0.20				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8634	001	0	1	04	01	H8634_001_0	6	Preferred Brand	4	010001	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					39.00		117.00							141.00																47.00				47.00			1.57	1.30				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8634	001	0	1	04	01	H8634_001_0	6	Non-Preferred Brand	4	110000	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								99.00		297.00					85.00		255.00							297.00																99.00				99.00			3.30	2.83				3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8634	001	0	1	04	01	H8634_001_0	6	Specialty Tier	4	010010	1	1	5	1		110	01	100		1				30		90	1	2			90				30		31											693.57	33		33				700.25	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8634	002	0	1	04	01	H8634_002_0	9	Preferred Generic	4	001000	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							27.00																9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8634	002	0	1	04	01	H8634_002_0	9	Preferred Generic	4	001000	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							27.00																9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8634	002	0	1	04	01	H8634_002_0	9	Generic	4	010010	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								20.00		60.00					9.00		27.00							60.00																20.00				20.00			0.67	0.30				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8634	002	0	1	04	01	H8634_002_0	9	Generic	4	010010	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								20.00		60.00					9.00		27.00							60.00																20.00				20.00			0.67	0.30				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8634	002	0	1	04	01	H8634_002_0	9	Preferred Brand	4	010001	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					39.00		117.00							141.00																47.00				47.00			1.57	1.30				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8634	002	0	1	04	01	H8634_002_0	9	Non-Preferred Brand	4	110000	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								100.00		300.00					95.00		285.00							300.00																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8634	002	0	1	04	01	H8634_002_0	9	Specialty Tier	4	010010	1	1	5	1		110	01	100		1				30		90	1	2			90				30		31											673.21	33		33				691.68	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8634	003	0	1	04	01	H8634_003_0	8	Preferred Generic	4	001000	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							27.00																9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8634	003	0	1	04	01	H8634_003_0	8	Preferred Generic	4	001000	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							27.00																9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8634	003	0	1	04	01	H8634_003_0	8	Generic	4	010010	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								15.00		45.00					6.00		18.00							45.00																15.00				15.00			0.50	0.20				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8634	003	0	1	04	01	H8634_003_0	8	Generic	4	010010	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								15.00		45.00					6.00		18.00							45.00																15.00				15.00			0.50	0.20				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8634	003	0	1	04	01	H8634_003_0	8	Preferred Brand	4	010001	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					39.00		117.00							141.00																47.00				47.00			1.57	1.30				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8634	003	0	1	04	01	H8634_003_0	8	Non-Preferred Brand	4	110000	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								99.00		297.00					85.00		255.00							297.00																99.00				99.00			3.30	2.83				3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8634	003	0	1	04	01	H8634_003_0	8	Specialty Tier	4	010010	1	1	5	1		110	01	100		1				30		90	1	2			90				30		31											745.24	33		33				733.18	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8634	004	0	1	04	01	H8634_004_0	8	Preferred Generic	4	001000	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							27.00																9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8634	004	0	1	04	01	H8634_004_0	8	Preferred Generic	4	001000	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							27.00																9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8634	004	0	1	04	01	H8634_004_0	8	Generic	4	010010	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								15.00		45.00					6.00		18.00							45.00																15.00				15.00			0.50	0.20				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8634	004	0	1	04	01	H8634_004_0	8	Generic	4	010010	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								15.00		45.00					6.00		18.00							45.00																15.00				15.00			0.50	0.20				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8634	004	0	1	04	01	H8634_004_0	8	Preferred Brand	4	010001	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					39.00		117.00							141.00																47.00				47.00			1.57	1.30				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8634	004	0	1	04	01	H8634_004_0	8	Non-Preferred Brand	4	110000	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								99.00		297.00					85.00		255.00							297.00																99.00				99.00			3.30	2.83				3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8634	004	0	1	04	01	H8634_004_0	8	Specialty Tier	4	010010	1	1	5	1		110	01	100		1				30		90	1	2			90				30		31											661.72	33		33				668.46	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8634	006	0	1	04	01	H8634_006_0	6	Preferred Generic	4	001000	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							27.00																9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8634	006	0	1	04	01	H8634_006_0	6	Preferred Generic	4	001000	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					0.00		0.00							27.00																9.00				9.00			0.30	0.00				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8634	006	0	1	04	01	H8634_006_0	6	Generic	4	010010	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								15.00		45.00					6.00		18.00							45.00																15.00				15.00			0.50	0.20				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8634	006	0	1	04	01	H8634_006_0	6	Generic	4	010010	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								15.00		45.00					6.00		18.00							45.00																15.00				15.00			0.50	0.20				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8634	006	0	1	04	01	H8634_006_0	6	Preferred Brand	4	010001	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					39.00		117.00							141.00																47.00				47.00			1.57	1.30				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8634	006	0	1	04	01	H8634_006_0	6	Non-Preferred Brand	4	110000	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								99.00		297.00					85.00		255.00							297.00																99.00				99.00			3.30	2.83				3.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8634	006	0	1	04	01	H8634_006_0	6	Specialty Tier	4	010010	1	1	5	1		110	01	100		1				30		90	1	2			90				30		31											764.74	33		33				759.57	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8649	003	0	1	01	01	H8649_003_0	7	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8649	003	0	1	01	01	H8649_003_0	7	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8649	003	0	1	01	01	H8649_003_0	7	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8649	003	0	1	01	01	H8649_003_0	7	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8649	003	0	1	01	01	H8649_003_0	7	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8649	003	0	1	01	01	H8649_003_0	7	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8649	003	0	1	01	01	H8649_003_0	7	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	25						1.00	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8649	008	0	1	01	01	H8649_008_0	5	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8649	008	0	1	01	01	H8649_008_0	5	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8649	008	0	1	01	01	H8649_008_0	5	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8649	008	0	1	01	01	H8649_008_0	5	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H8649	008	0	1	01	01	H8649_008_0	5	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	01	01	H8649_008_0	5	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	01	01	H8649_008_0	5	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	27						1.00	27												27						27						27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8677	001	0	1	48	05	H8677_001_0	9	Generic Drugs	4	010000			1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8677	001	0	1	48	05	H8677_001_0	9	Brand Drugs	4	010010			2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8677	001	0	1	48	05	H8677_001_0	9	Non-Medicare Rx/OTC Drugs	4	010010			3	1	010		01	010		1	31								31						31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8677	002	0	1	48	05	H8677_002_0	9	Generic Drugs	4	010000			1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8677	002	0	1	48	05	H8677_002_0	9	Brand Drugs	4	010010			2	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8677	002	0	1	48	05	H8677_002_0	9	Non-Medicare Rx/OTC Drugs	4	010010			3	1	010		01	010		1	31								31						31		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8748	002	0	1	01	01	H8748_002_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	002	0	1	01	01	H8748_002_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	002	0	1	01	01	H8748_002_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	002	0	1	01	01	H8748_002_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	002	0	1	01	01	H8748_002_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				894.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	008	0	1	01	01	H8748_008_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	008	0	1	01	01	H8748_008_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	008	0	1	01	01	H8748_008_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	008	0	1	01	01	H8748_008_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	008	0	1	01	01	H8748_008_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				768.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	009	0	1	01	01	H8748_009_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	009	0	1	01	01	H8748_009_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	009	0	1	01	01	H8748_009_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	009	0	1	01	01	H8748_009_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	009	0	1	01	01	H8748_009_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				870.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	010	0	1	01	01	H8748_010_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	010	0	1	01	01	H8748_010_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	010	0	1	01	01	H8748_010_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	010	0	1	01	01	H8748_010_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	010	0	1	01	01	H8748_010_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				768.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	011	0	1	01	01	H8748_011_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	011	0	1	01	01	H8748_011_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	011	0	1	01	01	H8748_011_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	011	0	1	01	01	H8748_011_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	011	0	1	01	01	H8748_011_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				870.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	012	0	1	01	01	H8748_012_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	012	0	1	01	01	H8748_012_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	012	0	1	01	01	H8748_012_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	012	0	1	01	01	H8748_012_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	012	0	1	01	01	H8748_012_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				768.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	013	0	1	01	01	H8748_013_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	013	0	1	01	01	H8748_013_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	013	0	1	01	01	H8748_013_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	013	0	1	01	01	H8748_013_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	013	0	1	01	01	H8748_013_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				859.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	014	0	1	01	01	H8748_014_0	5	Preferred Generic	3	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	014	0	1	01	01	H8748_014_0	5	Generic	3	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	014	0	1	01	01	H8748_014_0	5	Preferred Brand	3	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	014	0	1	01	01	H8748_014_0	5	Non-Preferred Drug	3	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	014	0	1	01	01	H8748_014_0	5	Specialty Tier	3	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				767.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	015	0	1	01	01	H8748_015_0	4	Preferred Generic	3	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	015	0	1	01	01	H8748_015_0	4	Generic	3	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	015	0	1	01	01	H8748_015_0	4	Preferred Brand	3	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	015	0	1	01	01	H8748_015_0	4	Non-Preferred Drug	3	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	015	0	1	01	01	H8748_015_0	4	Specialty Tier	3	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				767.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	017	0	1	01	01	H8748_017_0	4	Preferred Generic	3	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	017	0	1	01	01	H8748_017_0	4	Generic	3	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	017	0	1	01	01	H8748_017_0	4	Preferred Brand	3	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	017	0	1	01	01	H8748_017_0	4	Non-Preferred Drug	3	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	017	0	1	01	01	H8748_017_0	4	Specialty Tier	3	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				767.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	018	0	1	01	01	H8748_018_0	4	Preferred Generic	3	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	018	0	1	01	01	H8748_018_0	4	Generic	3	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	018	0	1	01	01	H8748_018_0	4	Preferred Brand	3	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	018	0	1	01	01	H8748_018_0	4	Non-Preferred Drug	3	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8748	018	0	1	01	01	H8748_018_0	4	Specialty Tier	3	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				767.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8764	001	0	1	01	01	H8764_001_0	5	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	2.00		4.00																					4.00																2.00				2.00		0.07						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8764	001	0	1	01	01	H8764_001_0	5	Preferred Generic	4	001000	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	2.00		4.00																					4.00																2.00				2.00		0.07						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8764	001	0	1	01	01	H8764_001_0	5	Generic	4	010000	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 Brand, Specialty Tier												
H8764	001	0	1	01	01	H8764_001_0	5	Generic	4	010000	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 Brand, Specialty Tier										1		
H8764	001	0	1	01	01	H8764_001_0	5	Preferred Brand	4	000001	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 Brand, Specialty Tier												
H8764	001	0	1	01	01	H8764_001_0	5	Non-Preferred Brand	4	100000	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 Brand, Specialty Tier												
H8764	001	0	1	01	01	H8764_001_0	5	Specialty Tier	4	010010	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31					30		30																				30															30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8764	002	0	1	02	01	H8764_002_0	7	Preferred Generic	4	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	2.00		4.00																					4.00																2.00				2.00		0.07						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8764	002	0	1	02	01	H8764_002_0	7	Preferred Generic	4	001000	1	2	1	3	110		01	100		1	30		90				1	2			90				30		31	2.00		4.00																					4.00																2.00				2.00		0.07						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H8764	002	0	1	02	01	H8764_002_0	7	Generic	4	010000	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 Brand, Specialty Tier												
H8764	002	0	1	02	01	H8764_002_0	7	Generic	4	010000	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 Brand, Specialty Tier										1		
H8764	002	0	1	02	01	H8764_002_0	7	Preferred Brand	4	000001	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 Brand, Specialty Tier												
H8764	002	0	1	02	01	H8764_002_0	7	Non-Preferred Brand	4	100000	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 Brand, Specialty Tier												
H8764	002	0	1	02	01	H8764_002_0	7	Specialty Tier	4	010010	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31					33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8764	003	0	1	01	01	H8764_003_0	5	Preferred Generic	3	001000	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 Brand, Specialty Tier												
H8764	003	0	1	01	01	H8764_003_0	5	Generic	3	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	15.00		30.00																					30.00																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8764	003	0	1	01	01	H8764_003_0	5	Preferred Brand	3	000001	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 Brand, Specialty Tier												
H8764	003	0	1	01	01	H8764_003_0	5	Non-Preferred Brand	3	100000	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 Brand, Specialty Tier												
H8764	003	0	1	01	01	H8764_003_0	5	Specialty Tier	3	010010	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31					25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H8786	001	0	1	48	05	H8786_001_0	4	Generic Drugs	4	010010			1	1	111		10	111		1	31	62	93				2	2	31	62	93					10	31																																														0.00			0.00			0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8786	001	0	1	48	05	H8786_001_0	4	Brand Drugs	4	010010			2	1	111		10	111		1	31	62	93				2	2	31	62	93					10	31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	0.00	8.25			0.00	8.25	0.00	8.25			
H8786	001	0	1	48	05	H8786_001_0	4	Non-Medicare Rx Drugs	4	010010			3	1	010		10			1	31															10	31																																														0.00						0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	2	0.00	0.00	0.00	0.00			0.00	0.00			
H8786	001	0	1	48	05	H8786_001_0	4	Non-Medicare OTC Drugs	4	010010			4	1	010		10			1	31															10	31																																														0.00						0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	2	0.00	0.00	0.00	0.00			0.00	0.00			
H8851	001	0	1	48	05	H8851_001_0	7	Generic Drugs	4	010000			1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8851	001	0	1	48	05	H8851_001_0	7	Brand Drugs	4	000010			2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8851	001	0	1	48	05	H8851_001_0	7	Non-Medicare Rx Drugs	4	010010			3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8851	001	0	1	48	05	H8851_001_0	7	Non-Medicare OTC Drugs	4	010010			4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H8854	001	0	1	01	01	H8854_001_0	8	Preferred Generic	4	001001	1	2	1	1	110		10	110		1	30		90				1	1	30		90					10	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												
H8854	001	0	1	01	01	H8854_001_0	8	Generic	4	010001	1	2	2	1	110		10	110		1	30		90				1	1	30		90					10	31	15.00		45.00																			15.00		45.00																	15.00			15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8854	001	0	1	01	01	H8854_001_0	8	Preferred Brand	4	000101	1	2	3	1	110		10	110		1	30		90				1	1	30		90					10	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												
H8854	001	0	1	01	01	H8854_001_0	8	Non-Preferred Drug	4	100100	1	2	4	1	110		10	110		1	30		90				1	1	30		90					10	31	100.00		300.00																			100.00		300.00																	100.00			100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8854	001	0	1	01	01	H8854_001_0	8	Specialty Tier	4	010010	1	1	5	1	110		10	110		1	30		90				1	1	30		90					10	31				198.00	33		33																		33		33																33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8908	001	0	1	01	01	H8908_001_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8908	001	0	1	01	01	H8908_001_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8908	001	0	1	01	01	H8908_001_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8908	001	0	1	01	01	H8908_001_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8908	001	0	1	01	01	H8908_001_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8908	001	0	1	01	01	H8908_001_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8908	001	0	1	01	01	H8908_001_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8908	001	0	1	01	01	H8908_001_0	4	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8908	001	0	1	01	01	H8908_001_0	4	Specialty Tier	4	010010	1	1	5	1		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	01	01	H8908_001_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8908	002	0	1	01	01	H8908_002_0	5	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8908	002	0	1	01	01	H8908_002_0	5	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8908	002	0	1	01	01	H8908_002_0	5	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8908	002	0	1	01	01	H8908_002_0	5	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8908	002	0	1	01	01	H8908_002_0	5	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8908	002	0	1	01	01	H8908_002_0	5	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8908	002	0	1	01	01	H8908_002_0	5	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8908	002	0	1	01	01	H8908_002_0	5	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H8908	002	0	1	01	01	H8908_002_0	5	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H8908	002	0	1	01	01	H8908_002_0	5	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
H9001	013	0	1	02	01	H9001_013_0	6	Preferred Generic	4	001000	1	2	1	1		111	01		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				1.00				1.00			0.20	0.03		0.20	0.03	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	013	0	1	02	01	H9001_013_0	6	Generic	4	010000	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					6.00	12.00	18.00											11.00	22.00	33.00				6.00	12.00	18.00				6.00				6.00			0.37	0.20		0.37	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	013	0	1	02	01	H9001_013_0	6	Preferred Brand	4	000001	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								37.00	74.00	111.00					32.00	64.00	96.00											37.00	74.00	111.00				32.00	64.00	96.00				32.00				32.00			1.23	1.07		1.23	1.07	1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	013	0	1	02	01	H9001_013_0	6	Non-Preferred Brand	4	100000	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								91.00	182.00	273.00					86.00	172.00	258.00											91.00	182.00	273.00				86.00	172.00	258.00				86.00				86.00			3.03	2.87		3.03	2.87	2.77	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	013	0	1	02	01	H9001_013_0	6	Specialty Tier	4	100100	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												27	27	27					27	27	27										27	27	27				27	27	27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	015	0	1	01	01	H9001_015_0	6	Preferred Generic	4	001000	1	2	1	1		111	01		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				1.00				1.00			0.20	0.03		0.20	0.03	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	015	0	1	01	01	H9001_015_0	6	Generic	4	010000	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					6.00	12.00	18.00											11.00	22.00	33.00				6.00	12.00	18.00				6.00				6.00			0.37	0.20		0.37	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	015	0	1	01	01	H9001_015_0	6	Preferred Brand	4	000001	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								37.00	74.00	111.00					32.00	64.00	96.00											37.00	74.00	111.00				32.00	64.00	96.00				32.00				32.00			1.23	1.07		1.23	1.07	1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	015	0	1	01	01	H9001_015_0	6	Non-Preferred Brand	4	100000	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								91.00	182.00	273.00					86.00	172.00	258.00											91.00	182.00	273.00				86.00	172.00	258.00				86.00				86.00			3.03	2.87		3.03	2.87	2.77	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	015	0	1	01	01	H9001_015_0	6	Specialty Tier	4	100100	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												29	29	29					29	29	29										29	29	29				29	29	29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	019	0	1	01	01	H9001_019_0	8	Generic	3	010000	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								Generic, Preferred Brand, Non-Preferred Brand												
H9001	019	0	1	01	01	H9001_019_0	8	Preferred Brand	3	000001	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								Generic, Preferred Brand, Non-Preferred Brand												
H9001	019	0	1	01	01	H9001_019_0	8	Non-Preferred Brand	3	100000	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								Generic, Preferred Brand, Non-Preferred Brand												
H9001	030	1	1	01	01	H9001_030_1	6	Preferred Generic	4	001000	1	2	1	1		111	01		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				1.00				1.00			0.20	0.03		0.20	0.03	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	030	1	1	01	01	H9001_030_1	6	Generic	4	010000	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					6.00	12.00	18.00											11.00	22.00	33.00				6.00	12.00	18.00				6.00				6.00			0.37	0.20		0.37	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	030	1	1	01	01	H9001_030_1	6	Preferred Brand	4	000001	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								37.00	74.00	111.00					32.00	64.00	96.00											37.00	74.00	111.00				32.00	64.00	96.00				32.00				32.00			1.23	1.07		1.23	1.07	1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	030	1	1	01	01	H9001_030_1	6	Non-Preferred Brand	4	100000	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								91.00	182.00	273.00					86.00	172.00	258.00											91.00	182.00	273.00				86.00	172.00	258.00				86.00				86.00			3.03	2.87		3.03	2.87	2.77	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	030	1	1	01	01	H9001_030_1	6	Specialty Tier	4	100100	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												27	27	27					27	27	27										27	27	27				27	27	27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	030	2	1	01	01	H9001_030_2	6	Preferred Generic	4	001000	1	2	1	1		111	01		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				1.00				1.00			0.20	0.03		0.20	0.03	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	030	2	1	01	01	H9001_030_2	6	Generic	4	010000	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					6.00	12.00	18.00											11.00	22.00	33.00				6.00	12.00	18.00				6.00				6.00			0.37	0.20		0.37	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	030	2	1	01	01	H9001_030_2	6	Preferred Brand	4	000001	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								37.00	74.00	111.00					32.00	64.00	96.00											37.00	74.00	111.00				32.00	64.00	96.00				32.00				32.00			1.23	1.07		1.23	1.07	1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	030	2	1	01	01	H9001_030_2	6	Non-Preferred Brand	4	100000	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								91.00	182.00	273.00					86.00	172.00	258.00											91.00	182.00	273.00				86.00	172.00	258.00				86.00				86.00			3.03	2.87		3.03	2.87	2.77	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	030	2	1	01	01	H9001_030_2	6	Specialty Tier	4	100100	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												27	27	27					27	27	27										27	27	27				27	27	27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	030	4	1	01	01	H9001_030_4	6	Preferred Generic	4	001000	1	2	1	1		111	01		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				1.00				1.00			0.20	0.03		0.20	0.03	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	030	4	1	01	01	H9001_030_4	6	Generic	4	010000	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					6.00	12.00	18.00											11.00	22.00	33.00				6.00	12.00	18.00				6.00				6.00			0.37	0.20		0.37	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	030	4	1	01	01	H9001_030_4	6	Preferred Brand	4	000001	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								37.00	74.00	111.00					32.00	64.00	96.00											37.00	74.00	111.00				32.00	64.00	96.00				32.00				32.00			1.23	1.07		1.23	1.07	1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	030	4	1	01	01	H9001_030_4	6	Non-Preferred Brand	4	100000	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								91.00	182.00	273.00					86.00	172.00	258.00											91.00	182.00	273.00				86.00	172.00	258.00				86.00				86.00			3.03	2.87		3.03	2.87	2.77	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	030	4	1	01	01	H9001_030_4	6	Specialty Tier	4	100100	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												27	27	27					27	27	27										27	27	27				27	27	27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	030	5	1	01	01	H9001_030_5	6	Preferred Generic	4	001000	1	2	1	1		111	01		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				1.00				1.00			0.20	0.03		0.20	0.03	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	030	5	1	01	01	H9001_030_5	6	Generic	4	010000	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					6.00	12.00	18.00											11.00	22.00	33.00				6.00	12.00	18.00				6.00				6.00			0.37	0.20		0.37	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	030	5	1	01	01	H9001_030_5	6	Preferred Brand	4	000001	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								37.00	74.00	111.00					32.00	64.00	96.00											37.00	74.00	111.00				32.00	64.00	96.00				32.00				32.00			1.23	1.07		1.23	1.07	1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	030	5	1	01	01	H9001_030_5	6	Non-Preferred Brand	4	100000	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								91.00	182.00	273.00					86.00	172.00	258.00											91.00	182.00	273.00				86.00	172.00	258.00				86.00				86.00			3.03	2.87		3.03	2.87	2.77	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	030	5	1	01	01	H9001_030_5	6	Specialty Tier	4	100100	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												27	27	27					27	27	27										27	27	27				27	27	27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	031	1	1	01	01	H9001_031_1	6	Preferred Generic	4	001000	1	2	1	1		111	01		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				1.00				1.00			0.20	0.03		0.20	0.03	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	031	1	1	01	01	H9001_031_1	6	Generic	4	010000	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					6.00	12.00	18.00											11.00	22.00	33.00				6.00	12.00	18.00				6.00				6.00			0.37	0.20		0.37	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	031	1	1	01	01	H9001_031_1	6	Preferred Brand	4	000001	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								37.00	74.00	111.00					32.00	64.00	96.00											37.00	74.00	111.00				32.00	64.00	96.00				32.00				32.00			1.23	1.07		1.23	1.07	1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	031	1	1	01	01	H9001_031_1	6	Non-Preferred Brand	4	100000	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								91.00	182.00	273.00					86.00	172.00	258.00											91.00	182.00	273.00				86.00	172.00	258.00				86.00				86.00			3.03	2.87		3.03	2.87	2.77	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	031	1	1	01	01	H9001_031_1	6	Specialty Tier	4	100100	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												33	33	33					33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	031	2	1	01	01	H9001_031_2	6	Preferred Generic	4	001000	1	2	1	1		111	01		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				1.00				1.00			0.20	0.03		0.20	0.03	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	031	2	1	01	01	H9001_031_2	6	Generic	4	010000	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					6.00	12.00	18.00											11.00	22.00	33.00				6.00	12.00	18.00				6.00				6.00			0.37	0.20		0.37	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	031	2	1	01	01	H9001_031_2	6	Preferred Brand	4	000001	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								37.00	74.00	111.00					32.00	64.00	96.00											37.00	74.00	111.00				32.00	64.00	96.00				32.00				32.00			1.23	1.07		1.23	1.07	1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	031	2	1	01	01	H9001_031_2	6	Non-Preferred Brand	4	100000	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								91.00	182.00	273.00					86.00	172.00	258.00											91.00	182.00	273.00				86.00	172.00	258.00				86.00				86.00			3.03	2.87		3.03	2.87	2.77	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	031	2	1	01	01	H9001_031_2	6	Specialty Tier	4	100100	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												33	33	33					33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	031	4	1	01	01	H9001_031_4	6	Preferred Generic	4	001000	1	2	1	1		111	01		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				1.00				1.00			0.20	0.03		0.20	0.03	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	031	4	1	01	01	H9001_031_4	6	Generic	4	010000	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					6.00	12.00	18.00											11.00	22.00	33.00				6.00	12.00	18.00				6.00				6.00			0.37	0.20		0.37	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	031	4	1	01	01	H9001_031_4	6	Preferred Brand	4	000001	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								37.00	74.00	111.00					32.00	64.00	96.00											37.00	74.00	111.00				32.00	64.00	96.00				32.00				32.00			1.23	1.07		1.23	1.07	1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	031	4	1	01	01	H9001_031_4	6	Non-Preferred Brand	4	100000	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								91.00	182.00	273.00					86.00	172.00	258.00											91.00	182.00	273.00				86.00	172.00	258.00				86.00				86.00			3.03	2.87		3.03	2.87	2.77	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	031	4	1	01	01	H9001_031_4	6	Specialty Tier	4	100100	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												33	33	33					33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	031	6	1	01	01	H9001_031_6	6	Preferred Generic	4	001000	1	2	1	1		111	01		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				1.00				1.00			0.20	0.03		0.20	0.03	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	031	6	1	01	01	H9001_031_6	6	Generic	4	010000	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					6.00	12.00	18.00											11.00	22.00	33.00				6.00	12.00	18.00				6.00				6.00			0.37	0.20		0.37	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	031	6	1	01	01	H9001_031_6	6	Preferred Brand	4	000001	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								37.00	74.00	111.00					32.00	64.00	96.00											37.00	74.00	111.00				32.00	64.00	96.00				32.00				32.00			1.23	1.07		1.23	1.07	1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	031	6	1	01	01	H9001_031_6	6	Non-Preferred Brand	4	100000	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								91.00	182.00	273.00					86.00	172.00	258.00											91.00	182.00	273.00				86.00	172.00	258.00				86.00				86.00			3.03	2.87		3.03	2.87	2.77	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	031	6	1	01	01	H9001_031_6	6	Specialty Tier	4	100100	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												33	33	33					33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	032	1	1	01	01	H9001_032_1	5	Preferred Generic	4	001000	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											7.00	14.00	21.00				2.00	4.00	6.00				2.00				2.00			0.23	0.07		0.23	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	032	1	1	01	01	H9001_032_1	5	Generic	4	010000	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00	24.00	36.00				7.00	14.00	21.00				7.00				7.00			0.40	0.23		0.40	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	032	1	1	01	01	H9001_032_1	5	Preferred Brand	4	000001	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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 Brand, Specialty Tier												
H9001	032	1	1	01	01	H9001_032_1	5	Non-Preferred Brand	4	100000	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				95.00				95.00			3.33	3.17		3.33	3.17	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	032	1	1	01	01	H9001_032_1	5	Specialty Tier	4	101000	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												25	25	25					25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	032	2	1	01	01	H9001_032_2	5	Preferred Generic	4	001000	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											7.00	14.00	21.00				2.00	4.00	6.00				2.00				2.00			0.23	0.07		0.23	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	032	2	1	01	01	H9001_032_2	5	Generic	4	010000	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00	24.00	36.00				7.00	14.00	21.00				7.00				7.00			0.40	0.23		0.40	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	032	2	1	01	01	H9001_032_2	5	Preferred Brand	4	000001	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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 Brand, Specialty Tier												
H9001	032	2	1	01	01	H9001_032_2	5	Non-Preferred Brand	4	100000	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				95.00				95.00			3.33	3.17		3.33	3.17	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	032	2	1	01	01	H9001_032_2	5	Specialty Tier	4	101000	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												25	25	25					25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	032	4	1	01	01	H9001_032_4	5	Preferred Generic	4	001000	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											7.00	14.00	21.00				2.00	4.00	6.00				2.00				2.00			0.23	0.07		0.23	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	032	4	1	01	01	H9001_032_4	5	Generic	4	010000	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00	24.00	36.00				7.00	14.00	21.00				7.00				7.00			0.40	0.23		0.40	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	032	4	1	01	01	H9001_032_4	5	Preferred Brand	4	000001	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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 Brand, Specialty Tier												
H9001	032	4	1	01	01	H9001_032_4	5	Non-Preferred Brand	4	100000	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				95.00				95.00			3.33	3.17		3.33	3.17	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	032	4	1	01	01	H9001_032_4	5	Specialty Tier	4	101000	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												25	25	25					25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	032	5	1	01	01	H9001_032_5	5	Preferred Generic	4	001000	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											7.00	14.00	21.00				2.00	4.00	6.00				2.00				2.00			0.23	0.07		0.23	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	032	5	1	01	01	H9001_032_5	5	Generic	4	010000	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00	24.00	36.00				7.00	14.00	21.00				7.00				7.00			0.40	0.23		0.40	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	032	5	1	01	01	H9001_032_5	5	Preferred Brand	4	000001	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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 Brand, Specialty Tier												
H9001	032	5	1	01	01	H9001_032_5	5	Non-Preferred Brand	4	100000	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				95.00				95.00			3.33	3.17		3.33	3.17	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	032	5	1	01	01	H9001_032_5	5	Specialty Tier	4	101000	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												25	25	25					25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	032	6	1	01	01	H9001_032_6	5	Preferred Generic	4	001000	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											7.00	14.00	21.00				2.00	4.00	6.00				2.00				2.00			0.23	0.07		0.23	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	032	6	1	01	01	H9001_032_6	5	Generic	4	010000	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00	24.00	36.00				7.00	14.00	21.00				7.00				7.00			0.40	0.23		0.40	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	032	6	1	01	01	H9001_032_6	5	Preferred Brand	4	000001	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								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 Brand, Specialty Tier												
H9001	032	6	1	01	01	H9001_032_6	5	Non-Preferred Brand	4	100000	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				95.00				95.00			3.33	3.17		3.33	3.17	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	032	6	1	01	01	H9001_032_6	5	Specialty Tier	4	101000	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												25	25	25					25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	033	0	1	02	01	H9001_033_0	6	Preferred Generic	4	001000	1	2	1	1		111	01		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				1.00				1.00			0.20	0.03		0.20	0.03	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	033	0	1	02	01	H9001_033_0	6	Generic	4	010000	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								11.00	22.00	33.00					6.00	12.00	18.00											11.00	22.00	33.00				6.00	12.00	18.00				6.00				6.00			0.37	0.20		0.37	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	033	0	1	02	01	H9001_033_0	6	Preferred Brand	4	000001	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								37.00	74.00	111.00					32.00	64.00	96.00											37.00	74.00	111.00				32.00	64.00	96.00				32.00				32.00			1.23	1.07		1.23	1.07	1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	033	0	1	02	01	H9001_033_0	6	Non-Preferred Brand	4	100000	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								91.00	182.00	273.00					86.00	172.00	258.00											91.00	182.00	273.00				86.00	172.00	258.00				86.00				86.00			3.03	2.87		3.03	2.87	2.77	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9001	033	0	1	02	01	H9001_033_0	6	Specialty Tier	4	100100	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												33	33	33					33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9003	001	0	1	01	01	H9003_001_0	17	Preferred Generic	4	001000	1	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		0.16			0.16			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	001	0	1	01	01	H9003_001_0	17	Preferred Generic	4	001000	1	2	1	3	110		01	110		1	30		90				2	2	30		90				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		0.16			0.16			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H9003	001	0	1	01	01	H9003_001_0	17	Generic	4	010000	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 Brand, Specialty Tier, Vaccines												
H9003	001	0	1	01	01	H9003_001_0	17	Generic	4	010000	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 Brand, Specialty Tier, Vaccines										1		
H9003	001	0	1	01	01	H9003_001_0	17	Preferred Brand	4	000001	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 Brand, Specialty Tier, Vaccines												
H9003	001	0	1	01	01	H9003_001_0	17	Non-Preferred Brand	4	100000	1	2	4	1	110		01	110		1	30		90				2	2	30		90				30		31	90.00		270.00																			90.00		180.00																90.00				90.00		3.00			3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	001	0	1	01	01	H9003_001_0	17	Specialty Tier	4	010010	1	1	5	1	110		01	110		1	30		90				2	2	30		90				30		31				1942.00	33		33																		33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	001	0	1	01	01	H9003_001_0	17	Vaccines	4	000001	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	001	0	1	01	01	H9003_001_0	17	Vaccines	4	000001	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H9003	006	0	1	01	01	H9003_006_0	17	Preferred Generic	4	001000	1	2	1	1	110		01	110		1	30		90				2	2	30		90				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		0.16			0.16			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	006	0	1	01	01	H9003_006_0	17	Preferred Generic	4	001000	1	2	1	3	110		01	110		1	30		90				2	2	30		90				30		31	5.00		15.00																			5.00		10.00																5.00				5.00		0.16			0.16			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H9003	006	0	1	01	01	H9003_006_0	17	Generic	4	010000	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 Brand, Specialty Tier, Vaccines												
H9003	006	0	1	01	01	H9003_006_0	17	Generic	4	010000	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 Brand, Specialty Tier, Vaccines										1		
H9003	006	0	1	01	01	H9003_006_0	17	Preferred Brand	4	000001	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 Brand, Specialty Tier, Vaccines												
H9003	006	0	1	01	01	H9003_006_0	17	Non-Preferred Brand	4	100000	1	2	4	1	110		01	110		1	30		90				2	2	30		90				30		31	90.00		270.00																			90.00		180.00																90.00				90.00		3.00			3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	006	0	1	01	01	H9003_006_0	17	Specialty Tier	4	010010	1	1	5	1	110		01	110		1	30		90				2	2	30		90				30		31				2044.00	33		33																		33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	006	0	1	01	01	H9003_006_0	17	Vaccines	4	000001	1	2	6	1	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines												
H9003	006	0	1	01	01	H9003_006_0	17	Vaccines	4	000001	1	2	6	3	010		01			1	30														30		31	0.00																																							0.00				0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Vaccines										1		
H9047	001	0	1	01	01	H9047_001_0	12	Preferred Generic	4	001000	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								12.00	24.00	36.00					6.00	12.00	14.40											12.00	24.00	36.00				6.00	12.00	14.40				12.00				12.00			0.40	0.20		0.40	0.20	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	001	0	1	01	01	H9047_001_0	12	Generic	4	010000	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					15.00	30.00	36.00											20.00	40.00	60.00				15.00	30.00	36.00				20.00				20.00			0.66	0.50		0.66	0.50	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	001	0	1	01	01	H9047_001_0	12	Preferred Brand	4	000001	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	112.80											47.00	94.00	141.00				47.00	94.00	112.80				47.00				47.00			1.56	1.56		1.56	1.56	1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	001	0	1	01	01	H9047_001_0	12	Non-Preferred Drug	4	100100	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											89.90	25	25	25				75.06	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	001	0	1	01	01	H9047_001_0	12	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		34											1863.63	33						1863.63	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	013	0	2	01	01	H9047_013_0	10	Preferred Generic	4	001000	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								12.00	24.00	36.00					6.00	12.00	14.40											12.00	24.00	36.00				6.00	12.00	14.40				12.00				12.00			0.40	0.20		0.40	0.20	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	013	0	2	01	01	H9047_013_0	10	Generic	4	010000	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					15.00	30.00	36.00											20.00	40.00	60.00				15.00	30.00	36.00				20.00				20.00			0.66	0.50		0.66	0.50	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	013	0	2	01	01	H9047_013_0	10	Preferred Brand	4	000001	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	112.80											47.00	94.00	141.00				47.00	94.00	112.80				47.00				47.00			1.56	1.56		1.56	1.56	1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	013	0	2	01	01	H9047_013_0	10	Non-Preferred Drug	4	100100	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											72.65	25	25	25				75.12	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	013	0	2	01	01	H9047_013_0	10	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		34											2394.62	33						2394.62	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	024	0	1	02	01	H9047_024_0	11	Preferred Generic	4	001000	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								12.00	24.00	36.00					6.00	12.00	14.40											12.00	24.00	36.00				6.00	12.00	14.40				12.00				12.00			0.40	0.20		0.40	0.20	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	024	0	1	02	01	H9047_024_0	11	Generic	4	010000	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					15.00	30.00	36.00											20.00	40.00	60.00				15.00	30.00	36.00				20.00				20.00			0.66	0.50		0.66	0.50	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	024	0	1	02	01	H9047_024_0	11	Preferred Brand	4	000001	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	112.80											47.00	94.00	141.00				47.00	94.00	112.80				47.00				47.00			1.56	1.56		1.56	1.56	1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	024	0	1	02	01	H9047_024_0	11	Non-Preferred Drug	4	100100	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											68.95	25	25	25				79.34	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	024	0	1	02	01	H9047_024_0	11	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		34											2366.92	30						2394.62	30												30						30					30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	037	0	1	02	01	H9047_037_0	11	Preferred Generic	4	001000	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								12.00	24.00	36.00					7.00	14.00	16.80											12.00	24.00	36.00				7.00	14.00	16.80				12.00				12.00			0.40	0.23		0.40	0.23	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	037	0	1	02	01	H9047_037_0	11	Generic	4	010000	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					15.00	30.00	36.00											20.00	40.00	60.00				15.00	30.00	36.00				20.00				20.00			0.66	0.50		0.66	0.50	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	037	0	1	02	01	H9047_037_0	11	Preferred Brand	4	000001	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	112.80											47.00	94.00	141.00				47.00	94.00	112.80				47.00				47.00			1.56	1.56		1.56	1.56	1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	037	0	1	02	01	H9047_037_0	11	Non-Preferred Drug	4	100100	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											93.84	25	25	25				56.75	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	037	0	1	02	01	H9047_037_0	11	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		34											1686.10	29						1686.10	29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	038	0	1	02	01	H9047_038_0	10	Preferred Generic	4	001000	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					4.00	8.00	9.60											10.00	20.00	30.00				4.00	8.00	9.60				10.00				10.00			0.33	0.13		0.33	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	038	0	1	02	01	H9047_038_0	10	Generic	4	010000	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					12.00	24.00	28.80											20.00	40.00	60.00				12.00	24.00	28.80				20.00				20.00			0.66	0.40		0.66	0.40	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	038	0	1	02	01	H9047_038_0	10	Preferred Brand	4	000001	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								45.00	90.00	135.00					45.00	90.00	108.00											45.00	90.00	135.00				45.00	90.00	108.00				45.00				45.00			1.50	1.50		1.50	1.50	1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	038	0	1	02	01	H9047_038_0	10	Non-Preferred Drug	4	100100	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											68.46	25	25	25				70.11	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	038	0	1	02	01	H9047_038_0	10	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		34											1992.42	33						1992.42	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	039	0	1	02	01	H9047_039_0	11	Preferred Generic	4	001000	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								12.00	24.00	36.00					10.00	20.00	24.00											12.00	24.00	36.00				10.00	20.00	24.00				12.00				12.00			0.40	0.33		0.40	0.33	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	039	0	1	02	01	H9047_039_0	11	Generic	4	010000	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					18.00	36.00	43.20											20.00	40.00	60.00				18.00	36.00	43.20				20.00				20.00			0.66	0.60		0.66	0.60	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	039	0	1	02	01	H9047_039_0	11	Preferred Brand	4	000001	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	112.80											47.00	94.00	141.00				47.00	94.00	112.80				47.00				47.00			1.56	1.56		1.56	1.56	1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	039	0	1	02	01	H9047_039_0	11	Non-Preferred Drug	4	100100	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											68.44	25	25	25				65.91	25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9047	039	0	1	02	01	H9047_039_0	11	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		34											1828.53	31						1828.53	31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9082	007	0	1	01	01	H9082_007_0	8	Preferred Generic	3	001001	1	2	1	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9082	007	0	1	01	01	H9082_007_0	8	Generic	3	010001	1	2	2	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												
H9082	007	0	1	01	01	H9082_007_0	8	Preferred Brand	3	000101	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												
H9082	007	0	1	01	01	H9082_007_0	8	Non-Preferred Drug	3	100100	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				68.33	50	50	50																		50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9082	007	0	1	01	01	H9082_007_0	8	Specialty Tier	3	010010	1	1	5	1	010		01	010		1	31								31						31		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9096	001	0	1	01	01	H9096_001_0	8	Preferred Generic	3	001000	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31	4.00	8.00	8.00																			4.00	8.00	8.00																	4.00			4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9096	001	0	1	01	01	H9096_001_0	8	Generic	3	010000	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31	14.00	28.00	28.00																			14.00	28.00	28.00																	14.00			14.00		0.47			0.47			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9096	001	0	1	01	01	H9096_001_0	8	Preferred Brand	3	000101	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31	47.00	94.00	117.50																			47.00	94.00	117.50																	47.00			47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9096	001	0	1	01	01	H9096_001_0	8	Non-Preferred Brand	3	100100	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9096	001	0	1	01	01	H9096_001_0	8	Specialty Tier	3	000010	1	1	5	1	010		10			1	30															29	31					25																																						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9096	002	0	1	01	01	H9096_002_0	7	Preferred Generic	4	001000	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31	3.00	6.00	6.00																			3.00	6.00	6.00																	3.00			3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9096	002	0	1	01	01	H9096_002_0	7	Generic	4	010000	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31	10.00	20.00	20.00																			10.00	20.00	20.00																	10.00			10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9096	002	0	1	01	01	H9096_002_0	7	Preferred Brand	4	000101	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31	47.00	94.00	117.50																			47.00	94.00	117.50																	47.00			47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9096	002	0	1	01	01	H9096_002_0	7	Non-Preferred Brand	4	100100	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9096	002	0	1	01	01	H9096_002_0	7	Specialty Tier	4	000010	1	1	5	1	010		10			1	30															29	31					27																																						27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9096	003	0	1	02	01	H9096_003_0	7	Preferred Generic	4	001000	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31	3.00	6.00	6.00																			3.00	6.00	6.00																	3.00			3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9096	003	0	1	02	01	H9096_003_0	7	Generic	4	010000	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31	8.00	16.00	16.00																			8.00	16.00	16.00																	8.00			8.00		0.27			0.27			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9096	003	0	1	02	01	H9096_003_0	7	Preferred Brand	4	000101	1	2	3	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31	47.00	94.00	117.50																			47.00	94.00	117.50																	47.00			47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9096	003	0	1	02	01	H9096_003_0	7	Non-Preferred Brand	4	100100	1	2	4	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31	100.00	200.00	300.00																			100.00	200.00	300.00																	100.00			100.00		3.33			3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9096	003	0	1	02	01	H9096_003_0	7	Specialty Tier	4	000010	1	1	5	1	010		10			1	30															29	31					33																																						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9104	006	0	1	01	01	H9104_006_0	6	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								3.00	6.00	9.00					0.00	0.00	0.00					0.00	0.00	0.00																3.00				3.00			0.10	0.00	0.00			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9104	006	0	1	01	01	H9104_006_0	6	Preferred Generic	4	001000	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					0.00	0.00	0.00																3.00				3.00			0.10	0.00	0.00			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H9104	006	0	1	01	01	H9104_006_0	6	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								10.00	20.00	30.00					5.00	10.00	15.00					5.00	10.00	15.00																10.00				10.00			0.33	0.17	0.17			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9104	006	0	1	01	01	H9104_006_0	6	Preferred Brand	4	010001	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					42.00	84.00	126.00																47.00				47.00			1.57	1.40	1.40			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9104	006	0	1	01	01	H9104_006_0	6	Non-Preferred Drug	4	100100	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					95.00	190.00	285.00																100.00				100.00			3.33	3.17	3.17			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9104	006	0	1	01	01	H9104_006_0	6	Specialty Tier	4	010010	1	1	5	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												
H9104	006	0	1	01	01	H9104_006_0	6	Select Care Drugs	4	000010	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				11.00			0.37	0.37	0.37			0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9115	001	0	1	48	05	H9115_001_0	3	Generic Drugs	4	010000			1	1	110		10	110		1	30		90				1	2	30		90					10	31																																														0.00			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			
H9115	001	0	1	48	05	H9115_001_0	3	Brand Drugs	4	000010			2	1	110		10	110		1	30		90				1	2	30		90					10	31																																														0.00			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			
H9115	001	0	1	48	05	H9115_001_0	3	Non-Medicare Rx/OTC Drugs	4	010010			3	1	110		10	110		1	30		90				1	2	30		90					10	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			
H9162	001	0	1	01	01	H9162_001_0	4	Preferred Generic	4	001001	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	4.00		12.00																					10.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9162	001	0	1	01	01	H9162_001_0	4	Generic	4	010001	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	10.00		30.00																					25.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9162	001	0	1	01	01	H9162_001_0	4	Preferred Brand	4	000101	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		141.00																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9162	001	0	1	01	01	H9162_001_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		300.00																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9162	001	0	1	01	01	H9162_001_0	4	Specialty Tier	4	010010	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31					33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9162	002	0	1	01	01	H9162_002_0	3	Preferred Generic	4	001001	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												
H9162	002	0	1	01	01	H9162_002_0	3	Generic	4	010001	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	10.00		30.00																					25.00																10.00				10.00		0.33						0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9162	002	0	1	01	01	H9162_002_0	3	Preferred Brand	4	000101	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		141.00																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9162	002	0	1	01	01	H9162_002_0	3	Non-Preferred Drug	4	100100	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		300.00																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9162	002	0	1	01	01	H9162_002_0	3	Specialty Tier	4	010010	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31					33		33																				33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9162	004	0	1	01	01	H9162_004_0	2	Preferred Generic	4	001001	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	6.00		18.00																					15.00																6.00				6.00		0.20						0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9162	004	0	1	01	01	H9162_004_0	2	Generic	4	010001	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	15.00		45.00																					37.50																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9162	004	0	1	01	01	H9162_004_0	2	Preferred Brand	4	000101	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	47.00		141.00																					117.50																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9162	004	0	1	01	01	H9162_004_0	2	Non-Preferred Drug	4	100100	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	100.00		300.00																					250.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9162	004	0	1	01	01	H9162_004_0	2	Specialty Tier	4	010010	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31					28		28																				28															28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9190	006	0	1	01	01	H9190_006_0	6	Preferred Generic	4	001000	1	2	1	1	111		01	100		1	30	60	90				1	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												
H9190	006	0	1	01	01	H9190_006_0	6	Generic	4	010000	1	2	2	1	111		01	100		1	30	60	90				1	1			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												
H9190	006	0	1	01	01	H9190_006_0	6	Preferred Brand	4	000001	1	2	3	1	111		01	100		1	30	60	90				1	1			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												
H9190	006	0	1	01	01	H9190_006_0	6	Non-Preferred Brand	4	100000	1	2	4	1	111		01	100		1	30	60	90				1	1			90				30		31	95.00	190.00	285.00																					285.00																95.00				95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9190	006	0	1	01	01	H9190_006_0	6	Specialty Tier	4	010010	1	1	5	1	111		01			1	30	60	90				1	1							30		31					28	28	28																																			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9190	012	0	1	01	01	H9190_012_0	6	Preferred Generic	4	001000	1	2	1	1	111		01	100		1	30	60	90				1	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												
H9190	012	0	1	01	01	H9190_012_0	6	Generic	4	010000	1	2	2	1	111		01	100		1	30	60	90				1	1			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												
H9190	012	0	1	01	01	H9190_012_0	6	Preferred Brand	4	000001	1	2	3	1	111		01	100		1	30	60	90				1	1			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												
H9190	012	0	1	01	01	H9190_012_0	6	Non-Preferred Brand	4	100000	1	2	4	1	111		01	100		1	30	60	90				1	1			90				30		31	95.00	190.00	285.00																					285.00																95.00				95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9190	012	0	1	01	01	H9190_012_0	6	Specialty Tier	4	010010	1	1	5	1	111		01			1	30	60	90				1	1							30		31					28	28	28																																			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9190	018	0	1	01	01	H9190_018_0	6	Preferred Generic	4	001000	1	2	1	1	111		01	100		1	30	60	90				1	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												
H9190	018	0	1	01	01	H9190_018_0	6	Generic	4	010000	1	2	2	1	111		01	100		1	30	60	90				1	1			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												
H9190	018	0	1	01	01	H9190_018_0	6	Preferred Brand	4	000001	1	2	3	1	111		01	100		1	30	60	90				1	1			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												
H9190	018	0	1	01	01	H9190_018_0	6	Non-Preferred Brand	4	100000	1	2	4	1	111		01	100		1	30	60	90				1	1			90				30		31	95.00	190.00	285.00																					285.00																95.00				95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9190	018	0	1	01	01	H9190_018_0	6	Specialty Tier	4	010010	1	1	5	1	111		01			1	30	60	90				1	1							30		31					28	28	28																																			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9190	019	0	1	01	01	H9190_019_0	8	Preferred Generic	4	001000	1	2	1	1	111		01	100		1	30	60	90				1	1			90				30		31	3.00	6.00	9.00																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9190	019	0	1	01	01	H9190_019_0	8	Generic	4	010000	1	2	2	1	111		01	100		1	30	60	90				1	1			90				30		31	16.00	32.00	48.00																					48.00																16.00				16.00		0.53						0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9190	019	0	1	01	01	H9190_019_0	8	Preferred Brand	4	000001	1	2	3	1	111		01	100		1	30	60	90				1	1			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												
H9190	019	0	1	01	01	H9190_019_0	8	Non-Preferred Brand	4	100000	1	2	4	1	111		01	100		1	30	60	90				1	1			90				30		31	95.00	190.00	285.00																					285.00																95.00				95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9190	019	0	1	01	01	H9190_019_0	8	Specialty Tier	4	010010	1	1	5	1	111		01			1	30	60	90				1	1							30		31					29	29	29																																			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9190	020	0	1	01	01	H9190_020_0	8	Preferred Generic	4	001000	1	2	1	1	111		01	100		1	30	60	90				1	1			90				30		31	3.00	6.00	9.00																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9190	020	0	1	01	01	H9190_020_0	8	Generic	4	010000	1	2	2	1	111		01	100		1	30	60	90				1	1			90				30		31	16.00	32.00	48.00																					48.00																16.00				16.00		0.53						0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9190	020	0	1	01	01	H9190_020_0	8	Preferred Brand	4	000001	1	2	3	1	111		01	100		1	30	60	90				1	1			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												
H9190	020	0	1	01	01	H9190_020_0	8	Non-Preferred Brand	4	100000	1	2	4	1	111		01	100		1	30	60	90				1	1			90				30		31	95.00	190.00	285.00																					285.00																95.00				95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9190	020	0	1	01	01	H9190_020_0	8	Specialty Tier	4	010010	1	1	5	1	111		01			1	30	60	90				1	1							30		31					29	29	29																																			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9190	021	0	1	01	01	H9190_021_0	9	Preferred Generic	4	001000	1	2	1	1	111		01	100		1	30	60	90				1	1			90				30		31	3.00	6.00	9.00																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9190	021	0	1	01	01	H9190_021_0	9	Generic	4	010000	1	2	2	1	111		01	100		1	30	60	90				1	1			90				30		31	16.00	32.00	48.00																					48.00																16.00				16.00		0.53						0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9190	021	0	1	01	01	H9190_021_0	9	Preferred Brand	4	000001	1	2	3	1	111		01	100		1	30	60	90				1	1			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												
H9190	021	0	1	01	01	H9190_021_0	9	Non-Preferred Brand	4	100000	1	2	4	1	111		01	100		1	30	60	90				1	1			90				30		31	95.00	190.00	285.00																					285.00																95.00				95.00		3.17						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9190	021	0	1	01	01	H9190_021_0	9	Specialty Tier	4	010010	1	1	5	1	111		01			1	30	60	90				1	1							30		31					29	29	29																																			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9207	002	0	1	01	01	H9207_002_0	5	Preferred Generic	4	001000	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	7.00	14.00	14.00																					14.00																7.00				7.00		0.23						0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9207	002	0	1	01	01	H9207_002_0	5	Generic	4	010000	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	20.00	40.00	40.00																					40.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9207	002	0	1	01	01	H9207_002_0	5	Preferred Brand	4	000001	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	94.00																					94.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9207	002	0	1	01	01	H9207_002_0	5	Non-Preferred Drug	4	100100	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				98.63	35	35	35																				35															35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9207	002	0	1	01	01	H9207_002_0	5	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31				1017.40	26																				26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9207	005	0	1	01	01	H9207_005_0	5	Preferred Generic	4	001000	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	7.00	14.00	14.00																					14.00																7.00				7.00		0.23						0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9207	005	0	1	01	01	H9207_005_0	5	Generic	4	010000	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	20.00	40.00	40.00																					40.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9207	005	0	1	01	01	H9207_005_0	5	Preferred Brand	4	000001	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	94.00																					94.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9207	005	0	1	01	01	H9207_005_0	5	Non-Preferred Drug	4	100100	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				98.63	35	35	35																				35															35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9207	005	0	1	01	01	H9207_005_0	5	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31				1017.40	26																				26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9207	007	0	1	01	01	H9207_007_0	7	Preferred Generic	3	001000	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	2.00	4.00	4.00																					4.00																2.00				2.00		0.07						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9207	007	0	1	01	01	H9207_007_0	7	Generic	3	010000	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	20.00	40.00	40.00																					40.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9207	007	0	1	01	01	H9207_007_0	7	Preferred Brand	3	000001	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	94.00																					94.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9207	007	0	1	01	01	H9207_007_0	7	Non-Preferred Drug	3	100100	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				98.43	34	34	34																				34															34			34								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9207	007	0	1	01	01	H9207_007_0	7	Specialty Tier	3	010010	1	1	5	1	010		01	010		1	30								30						30		31				893.63	26																				26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9207	008	0	1	01	01	H9207_008_0	7	Preferred Generic	3	001000	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	2.00	4.00	4.00																					4.00																2.00				2.00		0.07						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9207	008	0	1	01	01	H9207_008_0	7	Generic	3	010000	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	20.00	40.00	40.00																					40.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9207	008	0	1	01	01	H9207_008_0	7	Preferred Brand	3	000001	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	94.00																					94.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9207	008	0	1	01	01	H9207_008_0	7	Non-Preferred Drug	3	100100	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				98.43	34	34	34																				34															34			34								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9207	008	0	1	01	01	H9207_008_0	7	Specialty Tier	3	010010	1	1	5	1	010		01	010		1	30								30						30		31				893.63	26																				26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9207	009	0	1	01	01	H9207_009_0	7	Preferred Generic	3	001000	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	2.00	4.00	4.00																					4.00																2.00				2.00		0.07						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9207	009	0	1	01	01	H9207_009_0	7	Generic	3	010000	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	20.00	40.00	40.00																					40.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9207	009	0	1	01	01	H9207_009_0	7	Preferred Brand	3	000001	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	94.00																					94.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9207	009	0	1	01	01	H9207_009_0	7	Non-Preferred Drug	3	100100	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				98.43	34	34	34																				34															34			34								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9207	009	0	1	01	01	H9207_009_0	7	Specialty Tier	3	010010	1	1	5	1	010		01	010		1	30								30						30		31				893.63	26																				26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9207	010	0	1	01	01	H9207_010_0	5	Preferred Generic	4	001000	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	7.00	14.00	14.00																					14.00																7.00				7.00		0.23						0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9207	010	0	1	01	01	H9207_010_0	5	Generic	4	010000	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	20.00	40.00	40.00																					40.00																20.00				20.00		0.67						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9207	010	0	1	01	01	H9207_010_0	5	Preferred Brand	4	000001	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	94.00																					94.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9207	010	0	1	01	01	H9207_010_0	5	Non-Preferred Drug	4	100100	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				98.63	35	35	35																				35															35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9207	010	0	1	01	01	H9207_010_0	5	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31				1017.40	26																				26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9208	001	0	1	01	01	H9208_001_0	7	Preferred Generic	4	001000	1	2	1	1	111		01	100		1	31	62	93				1	2			93				31		31	3.00	6.00	7.50																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9208	001	0	1	01	01	H9208_001_0	7	Generic	4	010000	1	2	2	1	111		01	100		1	31	62	93				1	2			93				31		31	15.00	30.00	37.50																					45.00																15.00				15.00		0.48						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9208	001	0	1	01	01	H9208_001_0	7	Preferred Brand	4	000001	1	2	3	1	111		01	100		1	31	62	93				1	2			93				31		31	47.00	94.00	117.50																					141.00																47.00				47.00		1.52						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9208	001	0	1	01	01	H9208_001_0	7	Non-Preferred Brand	4	100100	1	1	4	1	111		01	100		1	31	62	93				1	2			93				31		31				53.24	50	50	50																				50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9208	001	0	1	01	01	H9208_001_0	7	Specialty Tier	4	010010	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												
H9208	002	0	1	01	01	H9208_002_0	7	Preferred Generic	4	001000	1	2	1	1	111		01	100		1	31	62	93				1	2			93				31		31	3.00	6.00	7.50																					9.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9208	002	0	1	01	01	H9208_002_0	7	Generic	4	010000	1	2	2	1	111		01	100		1	31	62	93				1	2			93				31		31	15.00	30.00	37.50																					45.00																15.00				15.00		0.48						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9208	002	0	1	01	01	H9208_002_0	7	Preferred Brand	4	000001	1	2	3	1	111		01	100		1	31	62	93				1	2			93				31		31	47.00	94.00	117.50																					141.00																47.00				47.00		1.52						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9208	002	0	1	01	01	H9208_002_0	7	Non-Preferred Brand	4	100100	1	1	4	1	111		01	100		1	31	62	93				1	2			93				31		31				49.31	50	50	50																				50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9208	002	0	1	01	01	H9208_002_0	7	Specialty Tier	4	010010	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												
H9276	001	0	1	01	01	H9276_001_0	5	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9276	001	0	1	01	01	H9276_001_0	5	Preferred Generic	4	001000	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H9276	001	0	1	01	01	H9276_001_0	5	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	14.00	28.00	42.00																			14.00	28.00	42.00																14.00				14.00		0.47			0.47			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9276	001	0	1	01	01	H9276_001_0	5	Generic	4	010000	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H9276	001	0	1	01	01	H9276_001_0	5	Preferred Brand	4	010001	1	2	3	1	111		01	111		1	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, Select Care Drugs												
H9276	001	0	1	01	01	H9276_001_0	5	Non-Preferred Brand	4	110000	1	2	4	1	111		01	111		1	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, Select Care Drugs												
H9276	001	0	1	01	01	H9276_001_0	5	Specialty Tier	4	010010	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 Brand, Specialty Tier, Select Care Drugs												
H9276	001	0	1	01	01	H9276_001_0	5	Select Care Drugs	4	010010	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9276	001	0	1	01	01	H9276_001_0	5	Select Care Drugs	4	010010	1	2	6	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H9276	002	0	1	01	01	H9276_002_0	5	Preferred Generic	3	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9276	002	0	1	01	01	H9276_002_0	5	Generic	3	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	14.00	28.00	42.00																			14.00	28.00	42.00																14.00				14.00		0.47			0.47			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9276	002	0	1	01	01	H9276_002_0	5	Preferred Brand	3	010001	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	45.00	90.00	135.00																			45.00	90.00	135.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9276	002	0	1	01	01	H9276_002_0	5	Non-Preferred Brand	3	110000	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	92.00	184.00	276.00																			92.00	184.00	276.00																92.00				92.00		3.07			3.07			2.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9276	002	0	1	01	01	H9276_002_0	5	Specialty Tier	3	010010	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 Brand, Specialty Tier, Select Care Drugs												
H9276	002	0	1	01	01	H9276_002_0	5	Select Care Drugs	3	010010	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9276	003	0	1	01	01	H9276_003_0	5	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9276	003	0	1	01	01	H9276_003_0	5	Preferred Generic	4	001000	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H9276	003	0	1	01	01	H9276_003_0	5	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	7.00	14.00	21.00																			7.00	14.00	21.00																7.00				7.00		0.23			0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9276	003	0	1	01	01	H9276_003_0	5	Preferred Brand	4	010001	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 Brand, Specialty Tier, Select Care Drugs												
H9276	003	0	1	01	01	H9276_003_0	5	Non-Preferred Brand	4	110000	1	2	4	1	111		01	111		1	30	60	90				1	2	30	60	90				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 Brand, Specialty Tier, Select Care Drugs												
H9276	003	0	1	01	01	H9276_003_0	5	Specialty Tier	4	010010	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 Brand, Specialty Tier, Select Care Drugs												
H9276	003	0	1	01	01	H9276_003_0	5	Select Care Drugs	4	010010	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9276	003	0	1	01	01	H9276_003_0	5	Select Care Drugs	4	010010	1	2	6	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H9276	004	0	1	01	01	H9276_004_0	5	Preferred Generic	4	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9276	004	0	1	01	01	H9276_004_0	5	Preferred Generic	4	001000	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H9276	004	0	1	01	01	H9276_004_0	5	Generic	4	010000	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 Care Drugs												
H9276	004	0	1	01	01	H9276_004_0	5	Generic	4	010000	1	2	2	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H9276	004	0	1	01	01	H9276_004_0	5	Preferred Brand	4	010001	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	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9276	004	0	1	01	01	H9276_004_0	5	Non-Preferred Brand	4	110000	1	2	4	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 Brand, Specialty Tier, Select Care Drugs												
H9276	004	0	1	01	01	H9276_004_0	5	Specialty Tier	4	010010	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 Brand, Specialty Tier, Select Care Drugs												
H9276	004	0	1	01	01	H9276_004_0	5	Select Care Drugs	4	010010	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9276	004	0	1	01	01	H9276_004_0	5	Select Care Drugs	4	010010	1	2	6	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H9287	001	0	1	01	01	H9287_001_0	4	Preferred Generic	4	001000	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 Brand, Specialty Tier, Select Care Drugs												
H9287	001	0	1	01	01	H9287_001_0	4	Generic	4	010000	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	18.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9287	001	0	1	01	01	H9287_001_0	4	Preferred Brand	4	010001	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	101.00				47.00				47.00			1.57	1.23		1.57	1.23	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9287	001	0	1	01	01	H9287_001_0	4	Non-Preferred Brand	4	110000	1	2	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								100.00	200.00	300.00					90.00	180.00	270.00											100.00	200.00	300.00				90.00	180.00	260.00				100.00				100.00			3.33	3.00		3.33	3.00	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9287	001	0	1	01	01	H9287_001_0	4	Specialty Tier	4	010010	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												33	33	33					33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9287	001	0	1	01	01	H9287_001_0	4	Select Care Drugs	4	010010	1	2	6	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								0.00	0.00	0.00					0.00	0.00	0.00											0.00	0.00	0.00				0.00	0.00	0.00				0.00				0.00			0.00	0.00		0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9302	003	0	1	01	01	H9302_003_0	6	Preferred Generic	4	001000	1	2	1	1	111		01	100		1	31	62	93				1	2			93				31		31	4.00	8.00	10.00																					12.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9302	003	0	1	01	01	H9302_003_0	6	Generic	4	010000	1	2	2	1	111		01	100		1	31	62	93				1	2			93				31		31	20.00	40.00	50.00																					60.00																20.00				20.00		0.65						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9302	003	0	1	01	01	H9302_003_0	6	Preferred Brand	4	000001	1	2	3	1	111		01	100		1	31	62	93				1	2			93				31		31	47.00	94.00	117.50																					141.00																47.00				47.00		1.52						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9302	003	0	1	01	01	H9302_003_0	6	Non-Preferred Brand	4	100100	1	1	4	1	111		01	100		1	31	62	93				1	2			93				31		31				72.80	50	50	50																				50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9302	003	0	1	01	01	H9302_003_0	6	Specialty Tier	4	010010	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												
H9302	007	0	1	01	01	H9302_007_0	6	Preferred Generic	4	001000	1	2	1	1	111		01	100		1	31	62	93				1	2			93				31		31	4.00	8.00	10.00																					12.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9302	007	0	1	01	01	H9302_007_0	6	Generic	4	010000	1	2	2	1	111		01	100		1	31	62	93				1	2			93				31		31	20.00	40.00	50.00																					60.00																20.00				20.00		0.65						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9302	007	0	1	01	01	H9302_007_0	6	Preferred Brand	4	000001	1	2	3	1	111		01	100		1	31	62	93				1	2			93				31		31	47.00	94.00	117.50																					141.00																47.00				47.00		1.52						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9302	007	0	1	01	01	H9302_007_0	6	Non-Preferred Brand	4	100100	1	1	4	1	111		01	100		1	31	62	93				1	2			93				31		31				61.99	50	50	50																				50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9302	007	0	1	01	01	H9302_007_0	6	Specialty Tier	4	010010	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												
H9302	011	0	1	01	01	H9302_011_0	5	Preferred Generic	4	001000	1	2	1	1	111		01	100		1	31	62	93				1	2			93				31		31	4.00	8.00	10.00																					12.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9302	011	0	1	01	01	H9302_011_0	5	Generic	4	010000	1	2	2	1	111		01	100		1	31	62	93				1	2			93				31		31	20.00	40.00	50.00																					60.00																20.00				20.00		0.65						0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9302	011	0	1	01	01	H9302_011_0	5	Preferred Brand	4	000001	1	2	3	1	111		01	100		1	31	62	93				1	2			93				31		31	47.00	94.00	117.50																					141.00																47.00				47.00		1.52						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9302	011	0	1	01	01	H9302_011_0	5	Non-Preferred Brand	4	100100	1	1	4	1	111		01	100		1	31	62	93				1	2			93				31		31				59.66	50	50	50																				50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9302	011	0	1	01	01	H9302_011_0	5	Specialty Tier	4	010010	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												
H9312	001	0	1	04	01	H9312_001_0	7	Preferred Generic	4	001000	1	2	1	1	110		10	100		1	31		90				1	2			90					10	31	0.00		0.00																					0.00																	0.00			0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9312	001	0	1	04	01	H9312_001_0	7	Generic	4	010000	1	1	2	1	110		10	100		1	31		90				1	2			90					10	31				14.90	25		25																				25																25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9312	001	0	1	04	01	H9312_001_0	7	Preferred Brand	4	000001	1	1	3	1	110		10	100		1	31		90				1	2			90					10	31				67.40	25		25																				25																25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9312	001	0	1	04	01	H9312_001_0	7	Non-Preferred Brand	4	100000	1	1	4	1	110		10	100		1	31		90				1	2			90					10	31				188.71	25		25																				25																25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9312	001	0	1	04	01	H9312_001_0	7	Specialty Tier	4	010010	1	1	5	1	010		10	010		1	31								30							10	31				600.00	25																				25																		25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9312	002	0	1	04	01	H9312_002_0	7	Preferred Generic	4	001000	1	2	1	1	110		10	100		1	31		90				1	2			90					10	31	0.00		0.00																					0.00																	0.00			0.00		0.00						0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9312	002	0	1	04	01	H9312_002_0	7	Generic	4	010000	1	1	2	1	110		10	100		1	31		90				1	2			90					10	31				14.90	25		25																				25																25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9312	002	0	1	04	01	H9312_002_0	7	Preferred Brand	4	000001	1	1	3	1	110		10	100		1	31		90				1	2			90					10	31				67.40	25		25																				25																25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9312	002	0	1	04	01	H9312_002_0	7	Non-Preferred Brand	4	100000	1	1	4	1	110		10	100		1	31		90				1	2			90					10	31				188.71	25		25																				25																25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9312	002	0	1	04	01	H9312_002_0	7	Specialty Tier	4	010010	1	1	5	1	010		10	010		1	31								30							10	31				600.00	25																				25																		25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9345	001	0	1	48	05	H9345_001_0	8	Generic Drugs	4	010000			1	1	111		01	110		1	30	60	90				1	2	30		90				30		31																																														0.00			0.00			0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H9345	001	0	1	48	05	H9345_001_0	8	Brand Drugs	4	000010			2	1	111		01	110		1	30	60	90				1	2	30		90				30		31																																														0.00			0.00			0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H9345	001	0	1	48	05	H9345_001_0	8	Non-Medicare Rx Drugs	4	010010			3	1	111		01	110		1	30	60	90				1	2	30		90				30		31																																														0.00			0.00			0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H9345	001	0	1	48	05	H9345_001_0	8	Non-Medicare OTC Drugs	4	010010			4	1	111		01	110		1	30	60	90				1	2	30		90				30		31																																														0.00			0.00			0.00	Generic Drugs, Brand Drugs, Non-Medicare Rx Drugs, Non-Medicare OTC Drugs	2	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H9403	003	0	1	01	01	H9403_003_0	11	Preferred Generic	4	001000	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	4.00	8.00	12.00																					8.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9403	003	0	1	01	01	H9403_003_0	11	Generic	4	010000	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	12.00	24.00	36.00																					24.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9403	003	0	1	01	01	H9403_003_0	11	Preferred Brand	4	000001	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					94.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9403	003	0	1	01	01	H9403_003_0	11	Non-Preferred Drug	4	100100	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					200.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9403	003	0	1	01	01	H9403_003_0	11	Specialty Tier	4	010010	1	1	5	1	111		01	100		1	30	60	90				1	2			90				30		31					28	28	28																				28															28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9403	003	0	1	01	01	H9403_003_0	11	Select Care Drugs	4	010010	1	2	6	1	111		01	100		1	30	60	90				1	2			90				30		31	11.00	22.00	33.00																					22.00																11.00				11.00		0.37						0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9403	004	0	1	01	01	H9403_004_0	10	Preferred Generic	4	001000	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	4.00	8.00	12.00																					8.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9403	004	0	1	01	01	H9403_004_0	10	Generic	4	010000	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	12.00	24.00	36.00																					24.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9403	004	0	1	01	01	H9403_004_0	10	Preferred Brand	4	000001	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												
H9403	004	0	1	01	01	H9403_004_0	10	Non-Preferred Brand	4	100100	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												
H9403	004	0	1	01	01	H9403_004_0	10	Specialty Tier	4	010010	1	1	5	1	111		01	100		1	30	60	90				1	2			90				30		31					28	28	28																				28															28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9408	001	0	1	04	01	H9408_001_0	9	Preferred Generic	4	001000	1	2	1	1		111	10	111		1				31	60	90	1	2	31	60	90					10	31								15.00	26.25	30.00					0.00	0.00	0.00					0.00	0.00	0.00																	15.00			15.00			0.48	0.00	0.00			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9408	001	0	1	04	01	H9408_001_0	9	Preferred Generic	4	001000	1	2	1	3		111	10	111		1				31	60	90	1	2	31	60	90					10	31								15.00	26.25	30.00					0.00	0.00	0.00					0.00	0.00	0.00																	15.00			15.00			0.48	0.00	0.00			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H9408	001	0	1	04	01	H9408_001_0	9	Generic	4	010000	1	2	2	1		111	10	111		1				31	60	90	1	2	31	60	90					10	31								20.00	35.00	40.00					15.00	26.25	30.00					15.00	26.25	30.00																	20.00			20.00			0.65	0.48	0.48			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9408	001	0	1	04	01	H9408_001_0	9	Preferred Brand	4	010001	1	2	3	1		111	10	111		1				31	60	90	1	2	31	60	90					10	31								47.00	82.25	94.00					42.00	73.50	84.00					42.00	73.50	84.00																	47.00			47.00			1.52	1.35	1.35			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9408	001	0	1	04	01	H9408_001_0	9	Non-Preferred Brand	4	110000	1	2	4	1		111	10	111		1				31	60	90	1	2	31	60	90					10	31								100.00	175.00	250.00					95.00	166.25	237.50					95.00	166.25	237.50																	100.00			100.00			3.23	3.06	3.06			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9408	001	0	1	04	01	H9408_001_0	9	Specialty Tier	4	010010	1	1	5	1		010	10	010		1				31					31							10	31												33							33						33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9408	001	0	1	04	01	H9408_001_0	9	Select Care Drugs	4	010000	1	2	6	1		111	10	111		1				31	60	90	1	2	31	60	90					10	31								5.00	8.75	10.00					0.00	0.00	0.00					0.00	0.00	0.00																	5.00			5.00			0.16	0.00	0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9408	001	0	1	04	01	H9408_001_0	9	Select Care Drugs	4	010000	1	2	6	3		111	10	111		1				31	60	90	1	2	31	60	90					10	31								5.00	8.75	10.00					0.00	0.00	0.00					0.00	0.00	0.00																	5.00			5.00			0.16	0.00	0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H9408	002	0	1	04	01	H9408_002_0	8	Preferred Generic	4	001000	1	2	1	1		111	10	111		1				31	60	90	1	2	31	60	90					10	31								10.00	17.50	20.00					0.00	0.00	0.00					0.00	0.00	0.00																	10.00			10.00			0.32	0.00	0.00			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9408	002	0	1	04	01	H9408_002_0	8	Preferred Generic	4	001000	1	2	1	3		111	10	111		1				31	60	90	1	2	31	60	90					10	31								10.00	17.50	20.00					0.00	0.00	0.00					0.00	0.00	0.00																	10.00			10.00			0.32	0.00	0.00			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H9408	002	0	1	04	01	H9408_002_0	8	Generic	4	010000	1	2	2	1		111	10	111		1				31	60	90	1	2	31	60	90					10	31								15.00	26.25	30.00					10.00	17.50	20.00					10.00	17.50	20.00																	15.00			15.00			0.48	0.32	0.32			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9408	002	0	1	04	01	H9408_002_0	8	Generic	4	010000	1	2	2	3		111	10	111		1				31	60	90	1	2	31	60	90					10	31								15.00	26.25	30.00					10.00	17.50	20.00					10.00	17.50	20.00																	15.00			15.00			0.48	0.32	0.32			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H9408	002	0	1	04	01	H9408_002_0	8	Preferred Brand	4	010001	1	2	3	1		111	10	111		1				31	60	90	1	2	31	60	90					10	31								40.00	70.00	80.00					35.00	61.25	70.00					35.00	61.25	70.00																	40.00			40.00			1.29	1.13	1.13			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9408	002	0	1	04	01	H9408_002_0	8	Non-Preferred Brand	4	110000	1	2	4	1		111	10	111		1				31	60	90	1	2	31	60	90					10	31								95.00	166.25	237.50					90.00	157.50	225.00					90.00	157.50	225.00																	95.00			95.00			3.06	2.90	2.90			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9408	002	0	1	04	01	H9408_002_0	8	Specialty Tier	4	010010	1	1	5	1		010	10	010		1				31					31							10	31												33							33						33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9408	002	0	1	04	01	H9408_002_0	8	Select Care Drugs	4	010000	1	2	6	1		111	10	111		1				31	60	90	1	2	31	60	90					10	31								5.00	8.75	10.00					0.00	0.00	0.00					0.00	0.00	0.00																	5.00			5.00			0.16	0.00	0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9408	002	0	1	04	01	H9408_002_0	8	Select Care Drugs	4	010000	1	2	6	3		111	10	111		1				31	60	90	1	2	31	60	90					10	31								5.00	8.75	10.00					0.00	0.00	0.00					0.00	0.00	0.00																	5.00			5.00			0.16	0.00	0.00			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs										1		
H9460	001	0	1	01	01	H9460_001_0	4	Preferred Generic	4	001000	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		31								7.00	14.00	21.00					2.00	4.00	0.00					7.00		21.00																7.00				7.00			0.23	0.07	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9460	001	0	1	01	01	H9460_001_0	4	Generic	4	010000	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		31								10.00	20.00	30.00					5.00	10.00	10.00					10.00		30.00																10.00				10.00			0.33	0.17	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9460	001	0	1	01	01	H9460_001_0	4	Preferred Brand	4	000101	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					47.00		141.00																47.00				47.00			1.57	1.40	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9460	001	0	1	01	01	H9460_001_0	4	Non-Preferred Drug	4	100100	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00		300.00																100.00				100.00			3.33	3.17	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9460	001	0	1	01	01	H9460_001_0	4	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		31											596.11	31						385.88	31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9487	001	0	1	48	05	H9487_001_0	5	Generic Drugs	4	010000			1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H9487	001	0	1	48	05	H9487_001_0	5	Brand Drugs	4	000010			2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0.00			
H9487	001	0	1	48	05	H9487_001_0	5	Non-Medicare Rx/OTC Drugs	4	010010			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			
H9525	003	0	1	01	01	H9525_003_0	7	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	003	0	1	01	01	H9525_003_0	7	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					9.00	18.00	27.00					9.00	27.00	27.00																9.00				9.00			0.30	0.30	0.30			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	003	0	1	01	01	H9525_003_0	7	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								46.00	92.00	138.00					46.00	92.00	138.00					46.00	138.00	138.00																46.00				46.00			1.53	1.53	1.53			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	003	0	1	01	01	H9525_003_0	7	Non-Preferred Drug	4	100100	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												
H9525	003	0	1	01	01	H9525_003_0	7	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	003	0	1	01	01	H9525_003_0	7	Select Care Drugs	4	001000	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			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	7	Select Care Drugs	4	001000	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H9525	004	0	1	01	01	H9525_004_0	7	Preferred Generic	4	001000	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												
H9525	004	0	1	01	01	H9525_004_0	7	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	004	0	1	01	01	H9525_004_0	7	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	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												
H9525	004	0	1	01	01	H9525_004_0	7	Non-Preferred Drug	4	100100	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												
H9525	004	0	1	01	01	H9525_004_0	7	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		34												30							30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	004	0	1	01	01	H9525_004_0	7	Select Care Drugs	4	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	004	0	1	01	01	H9525_004_0	7	Select Care Drugs	4	001000	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H9525	005	0	1	01	01	H9525_005_0	7	Preferred Generic	4	001000	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												
H9525	005	0	1	01	01	H9525_005_0	7	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	005	0	1	01	01	H9525_005_0	7	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	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												
H9525	005	0	1	01	01	H9525_005_0	7	Non-Preferred Drug	4	100100	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												
H9525	005	0	1	01	01	H9525_005_0	7	Specialty Tier	4	010010	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	005	0	1	01	01	H9525_005_0	7	Select Care Drugs	4	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	005	0	1	01	01	H9525_005_0	7	Select Care Drugs	4	001000	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								0.00	0.00	0.00					0.00	0.00	0.00					0.00	0.00	0.00																0.00				0.00			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
H9525	006	0	1	01	01	H9525_006_0	7	Preferred Generic	4	001000	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												
H9525	006	0	1	01	01	H9525_006_0	7	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								15.00	30.00	45.00					10.00	20.00	30.00					10.00	30.00	30.00																15.00				15.00			0.50	0.33	0.33			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	006	0	1	01	01	H9525_006_0	7	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	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												
H9525	006	0	1	01	01	H9525_006_0	7	Non-Preferred Drug	4	100100	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												
H9525	006	0	1	01	01	H9525_006_0	7	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		34												31							31						31																	31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	006	0	1	01	01	H9525_006_0	7	Select Care Drugs	4	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9525	006	0	1	01	01	H9525_006_0	7	Select Care Drugs	4	001000	1	2	6	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		
H9572	001	1	1	04	01	H9572_001_1	6	Preferred Generic	4	001000	1	2	1	1		110	01	110		1				31		90	1	2	31		90				31		31								3.00		9.00					3.00		7.50					3.00		7.50																3.00				3.00			0.10	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	001	1	1	04	01	H9572_001_1	6	Generic	4	010000	1	2	2	1		110	01	110		1				31		90	1	2	31		90				31		31								15.00		45.00					15.00		37.50					15.00		37.50																15.00				15.00			0.48	0.48	0.48			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	001	1	1	04	01	H9572_001_1	6	Preferred Brand	4	000001	1	2	3	1		110	01	110		1				31		90	1	2	31		90				31		31								45.00		135.00					45.00		112.50					45.00		112.50																45.00				45.00			1.45	1.45	1.45			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	001	1	1	04	01	H9572_001_1	6	Non-Preferred Drug	4	100100	1	1	4	1		110	01	110		1				31		90	1	2	31		90				31		31											59.00	45		45				59.00	45		42				45		42															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	001	1	1	04	01	H9572_001_1	6	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				31					31						31		31											1.00	30						1.00	30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	001	2	1	04	01	H9572_001_2	6	Preferred Generic	4	001000	1	2	1	1		110	01	110		1				31		90	1	2	31		90				31		31								3.00		9.00					3.00		7.50					3.00		7.50																3.00				3.00			0.10	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	001	2	1	04	01	H9572_001_2	6	Generic	4	010000	1	2	2	1		110	01	110		1				31		90	1	2	31		90				31		31								15.00		45.00					15.00		37.50					15.00		37.50																15.00				15.00			0.48	0.48	0.48			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	001	2	1	04	01	H9572_001_2	6	Preferred Brand	4	000001	1	2	3	1		110	01	110		1				31		90	1	2	31		90				31		31								45.00		135.00					45.00		112.50					45.00		112.50																45.00				45.00			1.45	1.45	1.45			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	001	2	1	04	01	H9572_001_2	6	Non-Preferred Drug	4	100100	1	1	4	1		110	01	110		1				31		90	1	2	31		90				31		31											59.00	45		45				59.00	45		42				45		42															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	001	2	1	04	01	H9572_001_2	6	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				31					31						31		31											1.00	30						1.00	30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	001	3	1	04	01	H9572_001_3	6	Preferred Generic	4	001000	1	2	1	1		110	01	110		1				31		90	1	2	31		90				31		31								3.00		9.00					3.00		7.50					3.00		7.50																3.00				3.00			0.10	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	001	3	1	04	01	H9572_001_3	6	Generic	4	010000	1	2	2	1		110	01	110		1				31		90	1	2	31		90				31		31								15.00		45.00					15.00		37.50					15.00		37.50																15.00				15.00			0.48	0.48	0.48			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	001	3	1	04	01	H9572_001_3	6	Preferred Brand	4	000001	1	2	3	1		110	01	110		1				31		90	1	2	31		90				31		31								45.00		135.00					45.00		112.50					45.00		112.50																45.00				45.00			1.45	1.45	1.45			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	001	3	1	04	01	H9572_001_3	6	Non-Preferred Drug	4	100100	1	1	4	1		110	01	110		1				31		90	1	2	31		90				31		31											59.00	45		45				59.00	45		42				45		42															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	001	3	1	04	01	H9572_001_3	6	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				31					31						31		31											1.00	30						1.00	30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	001	4	1	04	01	H9572_001_4	6	Preferred Generic	4	001000	1	2	1	1		110	01	110		1				31		90	1	2	31		90				31		31								3.00		9.00					3.00		7.50					3.00		7.50																3.00				3.00			0.10	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	001	4	1	04	01	H9572_001_4	6	Generic	4	010000	1	2	2	1		110	01	110		1				31		90	1	2	31		90				31		31								15.00		45.00					15.00		37.50					15.00		37.50																15.00				15.00			0.48	0.48	0.48			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	001	4	1	04	01	H9572_001_4	6	Preferred Brand	4	000001	1	2	3	1		110	01	110		1				31		90	1	2	31		90				31		31								45.00		135.00					45.00		112.50					45.00		112.50																45.00				45.00			1.45	1.45	1.45			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	001	4	1	04	01	H9572_001_4	6	Non-Preferred Drug	4	100100	1	1	4	1		110	01	110		1				31		90	1	2	31		90				31		31											59.00	45		45				59.00	45		42				45		42															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	001	4	1	04	01	H9572_001_4	6	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				31					31						31		31											1.00	30						1.00	30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	001	6	1	04	01	H9572_001_6	6	Preferred Generic	4	001000	1	2	1	1		110	01	110		1				31		90	1	2	31		90				31		31								3.00		9.00					3.00		7.50					3.00		7.50																3.00				3.00			0.10	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	001	6	1	04	01	H9572_001_6	6	Generic	4	010000	1	2	2	1		110	01	110		1				31		90	1	2	31		90				31		31								15.00		45.00					15.00		37.50					15.00		37.50																15.00				15.00			0.48	0.48	0.48			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	001	6	1	04	01	H9572_001_6	6	Preferred Brand	4	000001	1	2	3	1		110	01	110		1				31		90	1	2	31		90				31		31								45.00		135.00					45.00		112.50					45.00		112.50																45.00				45.00			1.45	1.45	1.45			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	001	6	1	04	01	H9572_001_6	6	Non-Preferred Drug	4	100100	1	1	4	1		110	01	110		1				31		90	1	2	31		90				31		31											59.00	45		45				59.00	45		42				45		42															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	001	6	1	04	01	H9572_001_6	6	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				31					31						31		31											1.00	30						1.00	30						30																	30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	003	1	1	04	01	H9572_003_1	6	Preferred Generic	4	001000	1	2	1	1		110	01	110		1				31		90	1	2	31		90				31		31								3.00		9.00					3.00		7.50					3.00		7.50																3.00				3.00			0.10	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	003	1	1	04	01	H9572_003_1	6	Generic	4	010000	1	2	2	1		110	01	110		1				31		90	1	2	31		90				31		31								14.00		42.00					14.00		35.00					14.00		35.00																14.00				14.00			0.45	0.45	0.45			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	003	1	1	04	01	H9572_003_1	6	Preferred Brand	4	000001	1	2	3	1		110	01	110		1				31		90	1	2	31		90				31		31								40.00		120.00					40.00		100.00					40.00		100.00																40.00				40.00			1.29	1.29	1.29			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	003	1	1	04	01	H9572_003_1	6	Non-Preferred Drug	4	100100	1	1	4	1		110	01	110		1				31		90	1	2	31		90				31		31											56.00	45		45				56.00	45		42				45		42															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	003	1	1	04	01	H9572_003_1	6	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				31					31						31		31											1.00	33						1.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	003	2	1	04	01	H9572_003_2	6	Preferred Generic	4	001000	1	2	1	1		110	01	110		1				31		90	1	2	31		90				31		31								3.00		9.00					3.00		7.50					3.00		7.50																3.00				3.00			0.10	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	003	2	1	04	01	H9572_003_2	6	Generic	4	010000	1	2	2	1		110	01	110		1				31		90	1	2	31		90				31		31								14.00		42.00					14.00		35.00					14.00		35.00																14.00				14.00			0.45	0.45	0.45			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	003	2	1	04	01	H9572_003_2	6	Preferred Brand	4	000001	1	2	3	1		110	01	110		1				31		90	1	2	31		90				31		31								40.00		120.00					40.00		100.00					40.00		100.00																40.00				40.00			1.29	1.29	1.29			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	003	2	1	04	01	H9572_003_2	6	Non-Preferred Drug	4	100100	1	1	4	1		110	01	110		1				31		90	1	2	31		90				31		31											56.00	45		45				56.00	45		42				45		42															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	003	2	1	04	01	H9572_003_2	6	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				31					31						31		31											1.00	33						1.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	003	3	1	04	01	H9572_003_3	6	Preferred Generic	4	001000	1	2	1	1		110	01	110		1				31		90	1	2	31		90				31		31								3.00		9.00					3.00		7.50					3.00		7.50																3.00				3.00			0.10	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	003	3	1	04	01	H9572_003_3	6	Generic	4	010000	1	2	2	1		110	01	110		1				31		90	1	2	31		90				31		31								14.00		42.00					14.00		35.00					14.00		35.00																14.00				14.00			0.45	0.45	0.45			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	003	3	1	04	01	H9572_003_3	6	Preferred Brand	4	000001	1	2	3	1		110	01	110		1				31		90	1	2	31		90				31		31								40.00		120.00					40.00		100.00					40.00		100.00																40.00				40.00			1.29	1.29	1.29			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	003	3	1	04	01	H9572_003_3	6	Non-Preferred Drug	4	100100	1	1	4	1		110	01	110		1				31		90	1	2	31		90				31		31											56.00	45		45				56.00	45		42				45		42															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	003	3	1	04	01	H9572_003_3	6	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				31					31						31		31											1.00	33						1.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	003	4	1	04	01	H9572_003_4	6	Preferred Generic	4	001000	1	2	1	1		110	01	110		1				31		90	1	2	31		90				31		31								3.00		9.00					3.00		7.50					3.00		7.50																3.00				3.00			0.10	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	003	4	1	04	01	H9572_003_4	6	Generic	4	010000	1	2	2	1		110	01	110		1				31		90	1	2	31		90				31		31								14.00		42.00					14.00		35.00					14.00		35.00																14.00				14.00			0.45	0.45	0.45			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	003	4	1	04	01	H9572_003_4	6	Preferred Brand	4	000001	1	2	3	1		110	01	110		1				31		90	1	2	31		90				31		31								40.00		120.00					40.00		100.00					40.00		100.00																40.00				40.00			1.29	1.29	1.29			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	003	4	1	04	01	H9572_003_4	6	Non-Preferred Drug	4	100100	1	1	4	1		110	01	110		1				31		90	1	2	31		90				31		31											56.00	45		45				56.00	45		42				45		42															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	003	4	1	04	01	H9572_003_4	6	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				31					31						31		31											1.00	33						1.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	003	6	1	04	01	H9572_003_6	6	Preferred Generic	4	001000	1	2	1	1		110	01	110		1				31		90	1	2	31		90				31		31								3.00		9.00					3.00		7.50					3.00		7.50																3.00				3.00			0.10	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	003	6	1	04	01	H9572_003_6	6	Generic	4	010000	1	2	2	1		110	01	110		1				31		90	1	2	31		90				31		31								14.00		42.00					14.00		35.00					14.00		35.00																14.00				14.00			0.45	0.45	0.45			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	003	6	1	04	01	H9572_003_6	6	Preferred Brand	4	000001	1	2	3	1		110	01	110		1				31		90	1	2	31		90				31		31								40.00		120.00					40.00		100.00					40.00		100.00																40.00				40.00			1.29	1.29	1.29			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	003	6	1	04	01	H9572_003_6	6	Non-Preferred Drug	4	100100	1	1	4	1		110	01	110		1				31		90	1	2	31		90				31		31											56.00	45		45				56.00	45		42				45		42															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9572	003	6	1	04	01	H9572_003_6	6	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				31					31						31		31											1.00	33						1.00	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	010000			1	1	010		01			1	30														30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	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	000010			2	1	010		01			1	30														30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	1	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	010010			3	1	010		01			1	30														30		31																																																					Generic Drugs, Brand Drugs, Non-Medicare Rx/OTC Drugs	2	0.00	0.00	0.00	0.00			0.00	0.00			
H9589	001	0	1	04	01	H9589_001_0	10	Preferred Generic	4	001000	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	4.00	8.00	12.00																					8.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9589	001	0	1	04	01	H9589_001_0	10	Generic	4	010000	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	12.00	24.00	36.00																					24.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9589	001	0	1	04	01	H9589_001_0	10	Preferred Brand	4	000001	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					94.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9589	001	0	1	04	01	H9589_001_0	10	Non-Preferred Drug	4	100100	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					200.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9589	001	0	1	04	01	H9589_001_0	10	Specialty Tier	4	010010	1	1	5	1	111		01	100		1	30	60	90				1	2			90				30		31					28	28	28																				28															28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9589	001	0	1	04	01	H9589_001_0	10	Select Care Drugs	4	010010	1	2	6	1	111		01	100		1	30	60	90				1	2			90				30		31	11.00	22.00	33.00																					22.00																11.00				11.00		0.37						0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9589	002	0	1	04	01	H9589_002_0	10	Preferred Generic	4	001000	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, Select Care Drugs												
H9589	002	0	1	04	01	H9589_002_0	10	Generic	4	010000	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	12.00	24.00	36.00																					24.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9589	002	0	1	04	01	H9589_002_0	10	Preferred Brand	4	000001	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	47.00	94.00	141.00																					94.00																47.00				47.00		1.57						1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9589	002	0	1	04	01	H9589_002_0	10	Non-Preferred Drug	4	100100	1	2	4	1	111		01	100		1	30	60	90				1	2			90				30		31	100.00	200.00	300.00																					200.00																100.00				100.00		3.33						3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9589	002	0	1	04	01	H9589_002_0	10	Specialty Tier	4	010010	1	1	5	1	111		01	100		1	30	60	90				1	2			90				30		31					28	28	28																				28															28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9589	002	0	1	04	01	H9589_002_0	10	Select Care Drugs	4	010010	1	2	6	1	111		01	100		1	30	60	90				1	2			90				30		31	11.00	22.00	33.00																					22.00																11.00				11.00		0.37						0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9589	003	0	1	04	01	H9589_003_0	9	Preferred Generic	4	001000	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	4.00	8.00	12.00																					8.00																4.00				4.00		0.13						0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9589	003	0	1	04	01	H9589_003_0	9	Generic	4	010000	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	12.00	24.00	36.00																					24.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9589	003	0	1	04	01	H9589_003_0	9	Preferred Brand	4	000001	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												
H9589	003	0	1	04	01	H9589_003_0	9	Non-Preferred Brand	4	100100	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												
H9589	003	0	1	04	01	H9589_003_0	9	Specialty Tier	4	010010	1	1	5	1	111		01	100		1	30	60	90				1	2			90				30		31					28	28	28																				28															28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9589	004	0	1	04	01	H9589_004_0	9	Preferred Generic	4	001000	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												
H9589	004	0	1	04	01	H9589_004_0	9	Generic	4	010000	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	12.00	24.00	36.00																					24.00																12.00				12.00		0.40						0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9589	004	0	1	04	01	H9589_004_0	9	Preferred Brand	4	000001	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												
H9589	004	0	1	04	01	H9589_004_0	9	Non-Preferred Brand	4	100100	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												
H9589	004	0	1	04	01	H9589_004_0	9	Specialty Tier	4	010010	1	1	5	1	111		01	100		1	30	60	90				1	2			90				30		31					28	28	28																				28															28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9595	001	0	1	01	01	H9595_001_0	8	Preferred Generic	3	001001	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												
H9595	001	0	1	01	01	H9595_001_0	8	Generic	3	010001	1	2	2	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	9.00																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9595	001	0	1	01	01	H9595_001_0	8	Preferred Brand	3	000101	1	2	3	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31	46.00	92.00	138.00																			46.00	92.00	138.00																46.00				46.00		1.48			1.48			1.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9595	001	0	1	01	01	H9595_001_0	8	Non-Preferred Drug	3	100100	1	1	4	1	111		01	111		1	31	60	90				1	2	31	60	90				31		31				71.79	44	44	44																		44	44	44															44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9595	001	0	1	01	01	H9595_001_0	8	Specialty Tier	3	010010	1	1	5	1	010		01	010		1	31								31						31		31					25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9615	007	0	1	04	01	H9615_007_0	15	Preferred Generic	4	001000	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		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												
H9615	007	0	1	04	01	H9615_007_0	15	Preferred Generic	4	001000	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, Vaccines										1		
H9615	007	0	1	04	01	H9615_007_0	15	Generic	4	010000	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		20.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9615	007	0	1	04	01	H9615_007_0	15	Preferred Brand	4	000101	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	35.00		105.00																									35.00		105.00				35.00		70.00				35.00				35.00		1.17				1.17	1.17	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9615	007	0	1	04	01	H9615_007_0	15	Non-Preferred Drug	4	100100	1	1	4	1	110		01		110	1	30		90				2	2				30		90	30		31				90.62	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9615	007	0	1	04	01	H9615_007_0	15	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				777.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9615	007	0	1	04	01	H9615_007_0	15	Vaccines	4	010010	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												
H9615	007	0	1	04	01	H9615_007_0	15	Vaccines	4	010010	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		
H9615	008	0	1	04	01	H9615_008_0	13	Preferred Generic	3	001000	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	2.00		6.00																									2.00		6.00				2.00		4.00				2.00				2.00		0.07				0.07	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9615	008	0	1	04	01	H9615_008_0	13	Generic	3	010000	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		20.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9615	008	0	1	04	01	H9615_008_0	13	Preferred Brand	3	000101	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9615	008	0	1	04	01	H9615_008_0	13	Non-Preferred Drug	3	100100	1	1	4	1	110		01		110	1	30		90				2	2				30		90	30		31				91.90	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9615	008	0	1	04	01	H9615_008_0	13	Specialty Tier	3	010010	1	1	5	1	010		01		010	1	30											30			30		31				715.00	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9615	008	0	1	04	01	H9615_008_0	13	Vaccines	3	010010	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												
H9615	009	0	1	04	01	H9615_009_0	13	Preferred Generic	4	001000	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		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												
H9615	009	0	1	04	01	H9615_009_0	13	Preferred Generic	4	001000	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, Vaccines										1		
H9615	009	0	1	04	01	H9615_009_0	13	Generic	4	010000	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		20.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9615	009	0	1	04	01	H9615_009_0	13	Preferred Brand	4	000101	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	35.00		105.00																									35.00		105.00				35.00		70.00				35.00				35.00		1.17				1.17	1.17	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9615	009	0	1	04	01	H9615_009_0	13	Non-Preferred Drug	4	100100	1	1	4	1	110		01		110	1	30		90				2	2				30		90	30		31				90.62	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9615	009	0	1	04	01	H9615_009_0	13	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				777.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9615	009	0	1	04	01	H9615_009_0	13	Vaccines	4	010010	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												
H9615	009	0	1	04	01	H9615_009_0	13	Vaccines	4	010010	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		
H9615	010	0	1	04	01	H9615_010_0	13	Preferred Generic	3	001000	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	2.00		6.00																									2.00		6.00				2.00		4.00				2.00				2.00		0.07				0.07	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9615	010	0	1	04	01	H9615_010_0	13	Generic	3	010000	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	10.00		30.00																									10.00		30.00				10.00		20.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9615	010	0	1	04	01	H9615_010_0	13	Preferred Brand	3	000101	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9615	010	0	1	04	01	H9615_010_0	13	Non-Preferred Drug	3	100100	1	1	4	1	110		01		110	1	30		90				2	2				30		90	30		31				91.67	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9615	010	0	1	04	01	H9615_010_0	13	Specialty Tier	3	010010	1	1	5	1	010		01		010	1	30											30			30		31				715.00	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9615	010	0	1	04	01	H9615_010_0	13	Vaccines	3	010010	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												
H9615	012	0	1	04	01	H9615_012_0	13	Preferred Generic	3	001000	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	1.00		3.00																									1.00		3.00				1.00		2.00				1.00				1.00		0.03				0.03	0.03	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9615	012	0	1	04	01	H9615_012_0	13	Generic	3	010000	1	2	2	1	110		01		110	1	30		90				2	2				30		90	30		31	11.00		33.00																									11.00		33.00				11.00		22.00				11.00				11.00		0.37				0.37	0.37	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9615	012	0	1	04	01	H9615_012_0	13	Preferred Brand	3	000101	1	2	3	1	110		01		110	1	30		90				2	2				30		90	30		31	47.00		141.00																									47.00		141.00				47.00		94.00				47.00				47.00		1.57				1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9615	012	0	1	04	01	H9615_012_0	13	Non-Preferred Drug	3	100100	1	1	4	1	110		01		110	1	30		90				2	2				30		90	30		31				91.62	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9615	012	0	1	04	01	H9615_012_0	13	Specialty Tier	3	010010	1	1	5	1	010		01		010	1	30											30			30		31				715.00	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Vaccines												
H9615	012	0	1	04	01	H9615_012_0	13	Vaccines	3	010010	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												
H9699	004	1	1	01	01	H9699_004_1	6	Preferred Generic	4	001000	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								10.00		20.00					3.00		6.00					3.00		6.00																10.00				3.00			0.33	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9699	004	1	1	01	01	H9699_004_1	6	Preferred Generic	4	001000	1	2	1	3		110	01	110		1				30		90	1	2	30		90				30		31								10.00		20.00					3.00		6.00					3.00		6.00																10.00				3.00			0.33	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H9699	004	1	1	01	01	H9699_004_1	6	Generic	4	010000	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								20.00		40.00					15.00		30.00					15.00		30.00																20.00				15.00			0.67	0.50	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9699	004	1	1	01	01	H9699_004_1	6	Preferred Brand	4	000001	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		94.00					42.00		84.00					42.00		84.00																47.00				42.00			1.57	1.40	1.40			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9699	004	1	1	01	01	H9699_004_1	6	Non-Preferred Brand	4	110000	1	2	4	1		110	01	110		1				30		90	1	2	30		90				30		31								100.00		200.00					95.00		190.00					95.00		190.00																100.00				95.00			3.33	3.17	3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9699	004	1	1	01	01	H9699_004_1	6	Specialty Tier	4	010010	1	1	5	1		110	01	110		1				30		90	1	2	30		90				30		31											1.00	33		33				1.00	33		33				33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9699	004	2	1	01	01	H9699_004_2	6	Preferred Generic	4	001000	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								10.00		20.00					3.00		6.00					3.00		6.00																10.00				3.00			0.33	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9699	004	2	1	01	01	H9699_004_2	6	Preferred Generic	4	001000	1	2	1	3		110	01	110		1				30		90	1	2	30		90				30		31								10.00		20.00					3.00		6.00					3.00		6.00																10.00				3.00			0.33	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H9699	004	2	1	01	01	H9699_004_2	6	Generic	4	010000	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								20.00		40.00					15.00		30.00					15.00		30.00																20.00				15.00			0.67	0.50	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9699	004	2	1	01	01	H9699_004_2	6	Preferred Brand	4	000001	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		94.00					42.00		84.00					42.00		84.00																47.00				42.00			1.57	1.40	1.40			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9699	004	2	1	01	01	H9699_004_2	6	Non-Preferred Brand	4	110000	1	2	4	1		110	01	110		1				30		90	1	2	30		90				30		31								100.00		200.00					95.00		190.00					95.00		190.00																100.00				95.00			3.33	3.17	3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9699	004	2	1	01	01	H9699_004_2	6	Specialty Tier	4	010010	1	1	5	1		110	01	110		1				30		90	1	2	30		90				30		31											1.00	33		33				1.00	33		33				33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9699	004	3	1	01	01	H9699_004_3	6	Preferred Generic	4	001000	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								10.00		20.00					3.00		6.00					3.00		6.00																10.00				3.00			0.33	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9699	004	3	1	01	01	H9699_004_3	6	Preferred Generic	4	001000	1	2	1	3		110	01	110		1				30		90	1	2	30		90				30		31								10.00		20.00					3.00		6.00					3.00		6.00																10.00				3.00			0.33	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
H9699	004	3	1	01	01	H9699_004_3	6	Generic	4	010000	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								20.00		40.00					15.00		30.00					15.00		30.00																20.00				15.00			0.67	0.50	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9699	004	3	1	01	01	H9699_004_3	6	Preferred Brand	4	000001	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		94.00					42.00		84.00					42.00		84.00																47.00				42.00			1.57	1.40	1.40			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9699	004	3	1	01	01	H9699_004_3	6	Non-Preferred Brand	4	110000	1	2	4	1		110	01	110		1				30		90	1	2	30		90				30		31								100.00		200.00					95.00		190.00					95.00		190.00																100.00				95.00			3.33	3.17	3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9699	004	3	1	01	01	H9699_004_3	6	Specialty Tier	4	010010	1	1	5	1		110	01	110		1				30		90	1	2	30		90				30		31											1.00	33		33				1.00	33		33				33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
H9712	001	0	1	48	05	H9712_001_0	3	Generic Drugs	4	010000			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			
H9712	001	0	1	48	05	H9712_001_0	3	Brand Drugs	4	000010			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			
H9725	001	0	1	01	01	H9725_001_0	5	Preferred Generic	4	001000	1	2	1	1		111	01	110		1				30	60	90	1	2	30		90				30		31								6.00	12.00	18.00					1.00	2.00	0.00					6.00		18.00																6.00				6.00			0.20	0.03	0.20			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9725	001	0	1	01	01	H9725_001_0	5	Generic	4	010000	1	2	2	1		111	01	110		1				30	60	90	1	2	30		90				30		31								20.00	40.00	60.00					15.00	30.00	37.50					20.00		60.00																20.00				20.00			0.67	0.50	0.67			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9725	001	0	1	01	01	H9725_001_0	5	Preferred Brand	4	000101	1	2	3	1		111	01	110		1				30	60	90	1	2	30		90				30		31								47.00	94.00	141.00					42.00	84.00	126.00					47.00		141.00																47.00				47.00			1.57	1.40	1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9725	001	0	1	01	01	H9725_001_0	5	Non-Preferred Drug	4	100100	1	2	4	1		111	01	110		1				30	60	90	1	2	30		90				30		31								100.00	200.00	300.00					95.00	190.00	285.00					100.00		300.00																100.00				100.00			3.33	3.17	3.33			3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9725	001	0	1	01	01	H9725_001_0	5	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		31											267.47	27						281.69	27						27																	27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9730	002	0	1	02	01	H9730_002_0	4	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9730	002	0	1	02	01	H9730_002_0	4	Generic	4	010001	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		25.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9730	002	0	1	02	01	H9730_002_0	4	Preferred Brand	4	000101	1	2	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												
H9730	002	0	1	02	01	H9730_002_0	4	Non-Preferred Drug	4	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				81.46	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9730	002	0	1	02	01	H9730_002_0	4	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				2423.17	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9730	003	0	1	01	01	H9730_003_0	4	Preferred Generic	3	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9730	003	0	1	01	01	H9730_003_0	4	Generic	3	010001	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		22.50				9.00				9.00		0.30				0.30	0.30	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9730	003	0	1	01	01	H9730_003_0	4	Preferred Brand	3	000101	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	43.00		129.00																									43.00		129.00				43.00		107.50				43.00				43.00		1.43				1.43	1.43	1.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9730	003	0	1	01	01	H9730_003_0	4	Non-Preferred Drug	3	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				97.79	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9730	003	0	1	01	01	H9730_003_0	4	Specialty Tier	3	010010	1	1	5	1	010		01		010	1	30											30			30		31				2197.05	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9730	004	0	1	01	01	H9730_004_0	4	Preferred Generic	3	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9730	004	0	1	01	01	H9730_004_0	4	Generic	3	010001	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		22.50				9.00				9.00		0.30				0.30	0.30	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9730	004	0	1	01	01	H9730_004_0	4	Preferred Brand	3	000101	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	41.00		123.00																									41.00		123.00				41.00		102.50				41.00				41.00		1.37				1.37	1.37	1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9730	004	0	1	01	01	H9730_004_0	4	Non-Preferred Drug	3	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				98.22	49		49																								49		49				49		49			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9730	004	0	1	01	01	H9730_004_0	4	Specialty Tier	3	010010	1	1	5	1	010		01		010	1	30											30			30		31				2188.06	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9808	004	0	1	04	01	H9808_004_0	8	Preferred Generic	4	001000	1	2	1	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	4.00	8.00	8.00																			4.00	8.00	8.00																	4.00			4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9808	004	0	1	04	01	H9808_004_0	8	Preferred Generic	4	001000	1	2	1	3	111		10	111		1	30	60	90				1	1	30	60	90					29	31	4.00	8.00	8.00																			4.00	8.00	8.00																	4.00			4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
H9808	004	0	1	04	01	H9808_004_0	8	Generic	4	010010	1	2	2	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	15.00	30.00	30.00																			15.00	30.00	30.00																	15.00			15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9808	004	0	1	04	01	H9808_004_0	8	Preferred Brand	4	010001	1	2	3	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	45.00	90.00	90.00																			45.00	90.00	90.00																	45.00			45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9808	004	0	1	04	01	H9808_004_0	8	Non-Preferred Drug	4	110000	1	2	4	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	85.00	170.00	170.00																			85.00	170.00	170.00																	85.00			85.00		2.83			2.83			2.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9808	004	0	1	04	01	H9808_004_0	8	Specialty Tier	4	010010	1	1	5	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31				946.71	33	33	33																		33	33	33																33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9808	005	0	1	04	01	H9808_005_0	7	Preferred Generic	4	001000	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	001000	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	010010	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	010001	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	110000	1	2	4	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31	75.00	150.00	150.00																			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												
H9808	005	0	1	04	01	H9808_005_0	7	Specialty Tier	4	010010	1	1	5	1	111		10	111		1	30	60	90				1	1	30	60	90					29	31				1109.21	33	33	33																		33	33	33																33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9811	001	0	1	01	01	H9811_001_0	7	Preferred Generic	3	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9811	001	0	1	01	01	H9811_001_0	7	Generic	3	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	45.00																			15.00	30.00	45.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9811	001	0	1	01	01	H9811_001_0	7	Preferred Brand	3	010001	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	36.00	72.00	108.00																			36.00	72.00	108.00																36.00				36.00		1.20			1.20			1.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9811	001	0	1	01	01	H9811_001_0	7	Non-Preferred Brand	3	110000	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				90.00		3.00			3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9811	001	0	1	01	01	H9811_001_0	7	Specialty Tier	3	010010	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 Brand, Specialty Tier, Select Care Drugs												
H9811	001	0	1	01	01	H9811_001_0	7	Select Care Drugs	3	010010	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9834	001	0	1	01	01	H9834_001_0	8	Preferred Generic	4	001000	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	3.00	6.00	9.00																					7.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9834	001	0	1	01	01	H9834_001_0	8	Generic	4	010000	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	15.00	30.00	45.00																					38.00																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9834	001	0	1	01	01	H9834_001_0	8	Preferred Brand	4	000001	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	45.00	90.00	135.00																					113.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9834	001	0	1	01	01	H9834_001_0	8	Non-Preferred Drug	4	100100	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				28.28	40	40	40																				40															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9834	001	0	1	01	01	H9834_001_0	8	Specialty Tier	4	010010	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												
H9834	003	0	1	01	01	H9834_003_0	9	Preferred Generic	4	001000	1	2	1	1	111		01	100		1	30	60	90				1	2			90				30		31	3.00	6.00	9.00																					7.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9834	003	0	1	01	01	H9834_003_0	9	Generic	4	010000	1	2	2	1	111		01	100		1	30	60	90				1	2			90				30		31	15.00	30.00	45.00																					38.00																15.00				15.00		0.50						0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9834	003	0	1	01	01	H9834_003_0	9	Preferred Brand	4	000001	1	2	3	1	111		01	100		1	30	60	90				1	2			90				30		31	45.00	90.00	135.00																					113.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9834	003	0	1	01	01	H9834_003_0	9	Non-Preferred Drug	4	100100	1	1	4	1	111		01	100		1	30	60	90				1	2			90				30		31				27.16	40	40	40																				40															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
H9834	003	0	1	01	01	H9834_003_0	9	Specialty Tier	4	010010	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												
H9869	001	0	1	48	05	H9869_001_0	7	Generic Drugs	4	010000			1	1	110		01			1	30		90				1	1							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			
H9869	001	0	1	48	05	H9869_001_0	7	Brand Drugs	4	000010			2	1	110		01			1	30		90				1	1							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			
H9869	001	0	1	48	05	H9869_001_0	7	Non-Medicare Rx/OTC Drugs	4	010010			3	1	110		01			1	30		90				1	1							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			
H9886	003	0	1	01	01	H9886_003_0	7	Preferred Generic	4	001000	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												
H9886	003	0	1	01	01	H9886_003_0	7	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								11.00	22.00	33.00					11.00	22.00	33.00					11.00	33.00	33.00																11.00				11.00			0.37	0.37	0.37			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9886	003	0	1	01	01	H9886_003_0	7	Preferred Brand	4	000101	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												
H9886	003	0	1	01	01	H9886_003_0	7	Non-Preferred Drug	4	100100	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												
H9886	003	0	1	01	01	H9886_003_0	7	Specialty Tier	4	010010	1	1	5	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												
H9886	003	0	1	01	01	H9886_003_0	7	Select Care Drugs	4	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9886	003	0	1	01	01	H9886_003_0	7	Select Care Drugs	4	001000	1	2	6	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		
H9886	004	0	1	01	01	H9886_004_0	7	Preferred Generic	4	001000	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												
H9886	004	0	1	01	01	H9886_004_0	7	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	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												
H9886	004	0	1	01	01	H9886_004_0	7	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	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												
H9886	004	0	1	01	01	H9886_004_0	7	Non-Preferred Drug	4	100100	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												
H9886	004	0	1	01	01	H9886_004_0	7	Specialty Tier	4	010010	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												
H9886	004	0	1	01	01	H9886_004_0	7	Select Care Drugs	4	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9886	004	0	1	01	01	H9886_004_0	7	Select Care Drugs	4	001000	1	2	6	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		
H9915	001	0	1	01	01	H9915_001_0	6	Preferred Generic	4	001000	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	10.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9915	001	0	1	01	01	H9915_001_0	6	Generic	4	010000	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 Brand, Specialty Tier, Select Care Drugs												
H9915	001	0	1	01	01	H9915_001_0	6	Preferred Brand	4	010001	1	2	3	1	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 Brand, Specialty Tier, Select Care Drugs												
H9915	001	0	1	01	01	H9915_001_0	6	Non-Preferred Brand	4	110000	1	2	4	1	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 Brand, Specialty Tier, Select Care Drugs												
H9915	001	0	1	01	01	H9915_001_0	6	Specialty Tier	4	010010	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												
H9915	001	0	1	01	01	H9915_001_0	6	Select Care Drugs	4	010000	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	7.50																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9915	007	0	1	01	01	H9915_007_0	4	Preferred Generic	4	001000	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	10.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H9915	007	0	1	01	01	H9915_007_0	4	Generic	4	010000	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 Brand, Specialty Tier, Select Diabetic Drugs												
H9915	007	0	1	01	01	H9915_007_0	4	Preferred Brand	4	010001	1	2	3	1	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 Brand, Specialty Tier, Select Diabetic Drugs												
H9915	007	0	1	01	01	H9915_007_0	4	Non-Preferred Brand	4	110000	1	2	4	1	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 Brand, Specialty Tier, Select Diabetic Drugs												
H9915	007	0	1	01	01	H9915_007_0	4	Specialty Tier	4	010010	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 Diabetic Drugs												
H9915	007	0	1	01	01	H9915_007_0	4	Select Diabetic Drugs	4	010010	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	25.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H9915	008	0	1	01	01	H9915_008_0	6	Preferred Generic	4	001000	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	10.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9915	008	0	1	01	01	H9915_008_0	6	Generic	4	010000	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 Brand, Specialty Tier, Select Care Drugs												
H9915	008	0	1	01	01	H9915_008_0	6	Preferred Brand	4	010001	1	2	3	1	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 Brand, Specialty Tier, Select Care Drugs												
H9915	008	0	1	01	01	H9915_008_0	6	Non-Preferred Brand	4	110000	1	2	4	1	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 Brand, Specialty Tier, Select Care Drugs												
H9915	008	0	1	01	01	H9915_008_0	6	Specialty Tier	4	010010	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												
H9915	008	0	1	01	01	H9915_008_0	6	Select Care Drugs	4	010000	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	3.00	6.00	9.00																			3.00	6.00	7.50																3.00				3.00		0.10			0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Care Drugs												
H9915	010	0	1	01	01	H9915_010_0	4	Preferred Generic	4	001000	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	10.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H9915	010	0	1	01	01	H9915_010_0	4	Generic	4	010000	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 Brand, Specialty Tier, Select Diabetic Drugs												
H9915	010	0	1	01	01	H9915_010_0	4	Preferred Brand	4	010001	1	2	3	1	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 Brand, Specialty Tier, Select Diabetic Drugs												
H9915	010	0	1	01	01	H9915_010_0	4	Non-Preferred Brand	4	110000	1	2	4	1	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 Brand, Specialty Tier, Select Diabetic Drugs												
H9915	010	0	1	01	01	H9915_010_0	4	Specialty Tier	4	010010	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 Diabetic Drugs												
H9915	010	0	1	01	01	H9915_010_0	4	Select Diabetic Drugs	4	010010	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	25.00																10.00				10.00		0.33			0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier, Select Diabetic Drugs												
H9947	006	0	1	04	01	H9947_006_0	7	Preferred Generic	4	001000	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												
H9947	006	0	1	04	01	H9947_006_0	7	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								18.00	36.00	54.00					13.00	26.00	39.00					13.00	39.00	39.00																18.00				18.00			0.60	0.43	0.43			0.53	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9947	006	0	1	04	01	H9947_006_0	7	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	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												
H9947	006	0	1	04	01	H9947_006_0	7	Non-Preferred Drug	4	100100	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								95.00	190.00	285.00					90.00	180.00	270.00					90.00	270.00	270.00																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												
H9947	006	0	1	04	01	H9947_006_0	7	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9947	006	0	1	04	01	H9947_006_0	7	Select Care Drugs	4	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9947	006	0	1	04	01	H9947_006_0	7	Select Care Drugs	4	001000	1	2	6	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		
H9954	002	0	1	01	01	H9954_002_0	7	Preferred Generic	4	001000	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												
H9954	002	0	1	01	01	H9954_002_0	7	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	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												
H9954	002	0	1	01	01	H9954_002_0	7	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	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												
H9954	002	0	1	01	01	H9954_002_0	7	Non-Preferred Drug	4	100100	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								97.00	194.00	291.00					92.00	184.00	276.00					92.00	276.00	276.00																97.00				97.00			3.23	3.07	3.07			2.85	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9954	002	0	1	01	01	H9954_002_0	7	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9954	002	0	1	01	01	H9954_002_0	7	Select Care Drugs	4	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9954	002	0	1	01	01	H9954_002_0	7	Select Care Drugs	4	001000	1	2	6	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		
H9954	004	0	1	01	01	H9954_004_0	6	Preferred Generic	4	001000	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												
H9954	004	0	1	01	01	H9954_004_0	6	Generic	4	010000	1	2	2	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												
H9954	004	0	1	01	01	H9954_004_0	6	Preferred Brand	4	000101	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												
H9954	004	0	1	01	01	H9954_004_0	6	Non-Preferred Drug	4	100100	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												
H9954	004	0	1	01	01	H9954_004_0	6	Specialty Tier	4	010010	1	1	5	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												
H9954	004	0	1	01	01	H9954_004_0	6	Select Care Drugs	4	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9954	004	0	1	01	01	H9954_004_0	6	Select Care Drugs	4	001000	1	2	6	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		
H9954	005	0	1	01	01	H9954_005_0	7	Preferred Generic	4	001000	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												
H9954	005	0	1	01	01	H9954_005_0	7	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	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												
H9954	005	0	1	01	01	H9954_005_0	7	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	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												
H9954	005	0	1	01	01	H9954_005_0	7	Non-Preferred Drug	4	100100	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												
H9954	005	0	1	01	01	H9954_005_0	7	Specialty Tier	4	010010	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												
H9954	005	0	1	01	01	H9954_005_0	7	Select Care Drugs	4	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9954	005	0	1	01	01	H9954_005_0	7	Select Care Drugs	4	001000	1	2	6	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		
H9954	006	0	1	01	01	H9954_006_0	6	Preferred Generic	4	001000	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												
H9954	006	0	1	01	01	H9954_006_0	6	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					12.00	24.00	36.00					12.00	36.00	36.00																17.00				17.00			0.57	0.40	0.40			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9954	006	0	1	01	01	H9954_006_0	6	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	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												
H9954	006	0	1	01	01	H9954_006_0	6	Non-Preferred Drug	4	100100	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												
H9954	006	0	1	01	01	H9954_006_0	6	Specialty Tier	4	010010	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												
H9954	006	0	1	01	01	H9954_006_0	6	Select Care Drugs	4	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
H9954	006	0	1	01	01	H9954_006_0	6	Select Care Drugs	4	001000	1	2	6	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		
R3332	001	0	1	31	11	R3332_001_0	12	Preferred Generic	3	001000	1	2	1	1		110	01	110		1				31		90	1	1	31		90				31		31								17.00		51.00					10.00		30.00					10.00		30.00																17.00				10.00			0.55	0.32	0.32			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R3332	001	0	1	31	11	R3332_001_0	12	Generic	3	010000	1	2	2	1		110	01	110		1				31		90	1	1	31		90				31		31								20.00		60.00					13.00		39.00					13.00		39.00																20.00				13.00			0.65	0.42	0.42			0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R3332	001	0	1	31	11	R3332_001_0	12	Preferred Brand	3	010001	1	2	3	1		110	01	110		1				31		90	1	1	31		90				31		31								47.00		141.00					40.00		120.00					40.00		120.00																47.00				40.00			1.52	1.29	1.29			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R3332	001	0	1	31	11	R3332_001_0	12	Non-Preferred Brand	3	110000	1	2	4	1		110	01	110		1				31		90	1	1	31		90				31		31								100.00		300.00					93.00		279.00					93.00		279.00																100.00				93.00			3.23	3.00	3.00			3.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R3332	001	0	1	31	11	R3332_001_0	12	Specialty Tier	3	010010	1	1	5	1		110	01	110		1				31		90	1	1	31		90				31		31											537.88	27		27				537.88	27		27				27		27															27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
R3444	009	0	1	31	11	R3444_009_0	4	Preferred Generic	3	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R3444	009	0	1	31	11	R3444_009_0	4	Generic	3	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R3444	009	0	1	31	11	R3444_009_0	4	Preferred Brand	3	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		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	4	Non-Preferred Drug	3	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		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	4	Specialty Tier	3	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				935.00	30		30																										30						30			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R3444	012	0	1	31	11	R3444_012_0	4	Preferred Generic	3	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R3444	012	0	1	31	11	R3444_012_0	4	Generic	3	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R3444	012	0	1	31	11	R3444_012_0	4	Preferred Brand	3	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		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	4	Non-Preferred Drug	3	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R3444	012	0	1	31	11	R3444_012_0	4	Specialty Tier	3	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				776.00	32		32																										32						32			32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5329	001	0	1	31	11	R5329_001_0	7	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5329	001	0	1	31	11	R5329_001_0	7	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5329	001	0	1	31	11	R5329_001_0	7	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5329	001	0	1	31	11	R5329_001_0	7	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5329	001	0	1	31	11	R5329_001_0	7	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				688.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5342	001	0	1	31	11	R5342_001_0	7	Preferred Generic	3	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5342	001	0	1	31	11	R5342_001_0	7	Generic	3	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5342	001	0	1	31	11	R5342_001_0	7	Preferred Brand	3	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		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	7	Non-Preferred Drug	3	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		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	7	Specialty Tier	3	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				678.00	27		27																										27						27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5342	005	0	1	31	11	R5342_005_0	6	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5342	005	0	1	31	11	R5342_005_0	6	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5342	005	0	1	31	11	R5342_005_0	6	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5342	005	0	1	31	11	R5342_005_0	6	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5342	005	0	1	31	11	R5342_005_0	6	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				739.00	30		30																										30						30			30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5342	006	0	1	31	11	R5342_006_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5342	006	0	1	31	11	R5342_006_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	8.00		24.00																											24.00						0.00				8.00				8.00		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5342	006	0	1	31	11	R5342_006_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	45.00		135.00																											135.00						125.00				45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5342	006	0	1	31	11	R5342_006_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	95.00		285.00																											285.00						275.00				95.00				95.00		3.16						3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5342	006	0	1	31	11	R5342_006_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				778.00	33		33																										33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	001	0	1	31	11	R5826_001_0	4	Preferred Generic	3	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	001	0	1	31	11	R5826_001_0	4	Generic	3	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	001	0	1	31	11	R5826_001_0	4	Preferred Brand	3	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	001	0	1	31	11	R5826_001_0	4	Non-Preferred Drug	3	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					95.00		285.00											100.00		300.00				95.00		275.00				100.00				100.00			3.33	3.17		3.33	3.17	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	001	0	1	31	11	R5826_001_0	4	Specialty Tier	3	010010	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	002	0	1	31	11	R5826_002_0	6	Preferred Generic	3	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					10.00		30.00											10.00		30.00				10.00		0.00				10.00				10.00			0.33	0.33		0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	002	0	1	31	11	R5826_002_0	6	Generic	3	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	002	0	1	31	11	R5826_002_0	6	Preferred Brand	3	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	002	0	1	31	11	R5826_002_0	6	Non-Preferred Drug	3	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	002	0	1	31	11	R5826_002_0	6	Specialty Tier	3	010010	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	005	0	1	31	11	R5826_005_0	3	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								8.00		24.00					3.00		9.00											8.00		24.00				3.00		0.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	005	0	1	31	11	R5826_005_0	3	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								8.00		24.00					3.00		9.00											8.00		24.00				3.00		0.00				8.00				8.00			0.27	0.10		0.27	0.10	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
R5826	005	0	1	31	11	R5826_005_0	3	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								13.00		39.00					8.00		24.00											13.00		39.00				8.00		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												
R5826	005	0	1	31	11	R5826_005_0	3	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								13.00		39.00					8.00		24.00											13.00		39.00				8.00		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										2	3	
R5826	005	0	1	31	11	R5826_005_0	3	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								45.00		135.00					40.00		120.00											45.00		135.00				40.00		110.00				45.00				45.00			1.50	1.33		1.50	1.33	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	005	0	1	31	11	R5826_005_0	3	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								45.00		135.00					40.00		120.00											45.00		135.00				40.00		110.00				45.00				45.00			1.50	1.33		1.50	1.33	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
R5826	005	0	1	31	11	R5826_005_0	3	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								90.00		270.00					85.00		255.00											90.00		270.00				85.00		245.00				90.00				90.00			3	2.83		3	2.83	2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	005	0	1	31	11	R5826_005_0	3	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								90.00		270.00					85.00		255.00											90.00		270.00				85.00		245.00				90.00				90.00			3	2.83		3	2.83	2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
R5826	005	0	1	31	11	R5826_005_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	005	0	1	31	11	R5826_005_0	3	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												31							31												31						31					31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
R5826	006	0	1	31	11	R5826_006_0	6	Preferred Generic	3	001010	1	1	1	1		110	01		110	1				30		90	2	2				30		90	30		31											1.00	25		25				1.00	20		20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	006	0	1	31	11	R5826_006_0	6	Generic	3	010001	1	1	2	1		110	01		110	1				30		90	2	2				30		90	30		31											3.00	25		25				3.00	25		25										25		25				25		25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	006	0	1	31	11	R5826_006_0	6	Preferred Brand	3	010001	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											29.00	25		25				29.00	25		25										25		25				25		25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	006	0	1	31	11	R5826_006_0	6	Non-Preferred Drug	3	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											39.00	25		25				38.00	25		25										25		25				25		25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	006	0	1	31	11	R5826_006_0	6	Specialty Tier	3	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	007	0	1	31	11	R5826_007_0	3	Preferred Generic	3	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	007	0	1	31	11	R5826_007_0	3	Generic	3	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	007	0	1	31	11	R5826_007_0	3	Preferred Brand	3	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	007	0	1	31	11	R5826_007_0	3	Non-Preferred Drug	3	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	007	0	1	31	11	R5826_007_0	3	Specialty Tier	3	010010	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	008	0	1	31	11	R5826_008_0	7	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	008	0	1	31	11	R5826_008_0	7	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
R5826	008	0	1	31	11	R5826_008_0	7	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	008	0	1	31	11	R5826_008_0	7	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
R5826	008	0	1	31	11	R5826_008_0	7	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	008	0	1	31	11	R5826_008_0	7	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
R5826	008	0	1	31	11	R5826_008_0	7	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	008	0	1	31	11	R5826_008_0	7	Non-Preferred Drug	4	110000	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		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
R5826	008	0	1	31	11	R5826_008_0	7	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	008	0	1	31	11	R5826_008_0	7	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
R5826	009	0	1	31	11	R5826_009_0	3	Preferred Generic	3	001010	1	1	1	1		110	01		110	1				30		90	2	2				30		90	30		31											1.00	25		25				1.00	20		20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	009	0	1	31	11	R5826_009_0	3	Generic	3	010001	1	1	2	1		110	01		110	1				30		90	2	2				30		90	30		31											3.00	25		25				3.00	25		25										25		25				25		25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	009	0	1	31	11	R5826_009_0	3	Preferred Brand	3	010001	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											31.00	25		25				31.00	25		25										25		25				25		25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	009	0	1	31	11	R5826_009_0	3	Non-Preferred Drug	3	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											46.00	25		25				45.00	25		25										25		25				25		25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	009	0	1	31	11	R5826_009_0	3	Specialty Tier	3	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	010	0	1	31	11	R5826_010_0	3	Preferred Generic	3	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								7.00		21.00					2.00		6.00											7.00		21.00				2.00		0.00				7.00				7.00			0.23	0.07		0.23	0.07	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	010	0	1	31	11	R5826_010_0	3	Generic	3	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								13.00		39.00					8.00		24.00											13.00		39.00				8.00		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												
R5826	010	0	1	31	11	R5826_010_0	3	Preferred Brand	3	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	010	0	1	31	11	R5826_010_0	3	Non-Preferred Drug	3	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	010	0	1	31	11	R5826_010_0	3	Specialty Tier	3	010010	1	1	5	1		010	01		010	1				30								30			30		31												28							28												28						28					28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	011	0	1	31	11	R5826_011_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	011	0	1	31	11	R5826_011_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
R5826	011	0	1	31	11	R5826_011_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	011	0	1	31	11	R5826_011_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		0.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
R5826	011	0	1	31	11	R5826_011_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	011	0	1	31	11	R5826_011_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
R5826	011	0	1	31	11	R5826_011_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	011	0	1	31	11	R5826_011_0	4	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
R5826	011	0	1	31	11	R5826_011_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	011	0	1	31	11	R5826_011_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
R5826	012	0	1	31	11	R5826_012_0	4	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	012	0	1	31	11	R5826_012_0	4	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
R5826	012	0	1	31	11	R5826_012_0	4	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								17.00		51.00					12.00		36.00											17.00		51.00				12.00		0.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	012	0	1	31	11	R5826_012_0	4	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								17.00		51.00					12.00		36.00											17.00		51.00				12.00		0.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
R5826	012	0	1	31	11	R5826_012_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	012	0	1	31	11	R5826_012_0	4	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
R5826	012	0	1	31	11	R5826_012_0	4	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	012	0	1	31	11	R5826_012_0	4	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
R5826	012	0	1	31	11	R5826_012_0	4	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	012	0	1	31	11	R5826_012_0	4	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												29							29												29						29					29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
R5826	013	0	1	31	11	R5826_013_0	3	Preferred Generic	3	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								7.00		21.00					2.00		6.00											7.00		21.00				2.00		0.00				7.00				7.00			0.23	0.07		0.23	0.07	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	013	0	1	31	11	R5826_013_0	3	Generic	3	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					5.00		15.00											10.00		30.00				5.00		0.00				10.00				10.00			0.33	0.17		0.33	0.17	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	013	0	1	31	11	R5826_013_0	3	Preferred Brand	3	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	013	0	1	31	11	R5826_013_0	3	Non-Preferred Drug	3	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	013	0	1	31	11	R5826_013_0	3	Specialty Tier	3	010010	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												
R5826	014	0	1	31	11	R5826_014_0	3	Preferred Generic	3	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	014	0	1	31	11	R5826_014_0	3	Generic	3	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								17.00		51.00					12.00		36.00											17.00		51.00				12.00		0.00				17.00				17.00			0.57	0.40		0.57	0.40	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	014	0	1	31	11	R5826_014_0	3	Preferred Brand	3	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	014	0	1	31	11	R5826_014_0	3	Non-Preferred Drug	3	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	014	0	1	31	11	R5826_014_0	3	Specialty Tier	3	010010	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												
R5826	074	0	1	31	11	R5826_074_0	4	Preferred Generic	3	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								6.00		18.00					6.00		18.00											6.00		18.00				6.00		0.00				6.00				6.00			0.20	0.20		0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	074	0	1	31	11	R5826_074_0	4	Generic	3	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	074	0	1	31	11	R5826_074_0	4	Preferred Brand	3	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	074	0	1	31	11	R5826_074_0	4	Non-Preferred Drug	3	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	074	0	1	31	11	R5826_074_0	4	Specialty Tier	3	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	077	0	1	31	11	R5826_077_0	3	Preferred Generic	3	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					7.00		21.00											10.00		30.00				7.00		0.00				10.00				10.00			0.33	0.23		0.33	0.23	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	077	0	1	31	11	R5826_077_0	3	Generic	3	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					17.00		51.00											20.00		60.00				17.00		0.00				20.00				20.00			0.67	0.57		0.67	0.57	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	077	0	1	31	11	R5826_077_0	3	Preferred Brand	3	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	077	0	1	31	11	R5826_077_0	3	Non-Preferred Drug	3	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					97.00		291.00											100.00		300.00				97.00		281.00				100.00				100.00			3.33	3.23		3.33	3.23	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	077	0	1	31	11	R5826_077_0	3	Specialty Tier	3	010010	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												
R5826	078	0	1	31	11	R5826_078_0	4	Preferred Generic	3	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0		0.17	0	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	078	0	1	31	11	R5826_078_0	4	Generic	3	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	078	0	1	31	11	R5826_078_0	4	Preferred Brand	3	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	078	0	1	31	11	R5826_078_0	4	Non-Preferred Drug	3	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					100.00		300.00											100.00		300.00				100.00		290.00				100.00				100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	078	0	1	31	11	R5826_078_0	4	Specialty Tier	3	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	079	0	1	31	11	R5826_079_0	3	Preferred Generic	3	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					9.00		27.00											10.00		30.00				9.00		0.00				10.00				10.00			0.33	0.30		0.33	0.30	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	079	0	1	31	11	R5826_079_0	3	Generic	3	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					20.00		60.00											20.00		60.00				20.00		0.00				20.00				20.00			0.67	0.67		0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	079	0	1	31	11	R5826_079_0	3	Preferred Brand	3	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	079	0	1	31	11	R5826_079_0	3	Non-Preferred Drug	3	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	079	0	1	31	11	R5826_079_0	3	Specialty Tier	3	010010	1	1	5	1		010	01		010	1				30								30			30		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	091	0	1	31	11	R5826_091_0	6	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	091	0	1	31	11	R5826_091_0	6	Preferred Generic	4	001010	1	2	1	3		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					6.00		18.00											10.00		30.00				6.00		0.00				10.00				10.00			0.33	0.20		0.33	0.20	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
R5826	091	0	1	31	11	R5826_091_0	6	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								18.00		54.00					13.00		39.00											18.00		54.00				13.00		0.00				18.00				18.00			0.60	0.43		0.60	0.43	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	091	0	1	31	11	R5826_091_0	6	Generic	4	010001	1	2	2	3		110	01		110	1				30		90	2	2				30		90	30		31								18.00		54.00					13.00		39.00											18.00		54.00				13.00		0.00				18.00				18.00			0.60	0.43		0.60	0.43	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
R5826	091	0	1	31	11	R5826_091_0	6	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	091	0	1	31	11	R5826_091_0	6	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					47.00		141.00											47.00		141.00				47.00		131.00				47.00				47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
R5826	091	0	1	31	11	R5826_091_0	6	Non-Preferred Drug	4	110000	1	2	4	1		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	091	0	1	31	11	R5826_091_0	6	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								100.00		300.00					99.00		297.00											100.00		300.00				99.00		287.00				100.00				100.00			3.33	3.30		3.33	3.30	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
R5826	091	0	1	31	11	R5826_091_0	6	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R5826	091	0	1	31	11	R5826_091_0	6	Specialty Tier	4	010010	1	1	5	3		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	3	
R5941	014	0	1	31	11	R5941_014_0	7	Preferred Generic	4	001000	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												
R5941	014	0	1	31	11	R5941_014_0	7	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	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												
R5941	014	0	1	31	11	R5941_014_0	7	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	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												
R5941	014	0	1	31	11	R5941_014_0	7	Non-Preferred Drug	4	100100	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												
R5941	014	0	1	31	11	R5941_014_0	7	Specialty Tier	4	010010	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	7	Select Care Drugs	4	001000	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			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	7	Select Care Drugs	4	001000	1	2	6	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		
R5941	015	0	1	31	11	R5941_015_0	7	Preferred Generic	4	001000	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												
R5941	015	0	1	31	11	R5941_015_0	7	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								18.00	36.00	54.00					13.00	26.00	39.00					13.00	39.00	39.00																18.00				18.00			0.60	0.43	0.43			0.53	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
R5941	015	0	1	31	11	R5941_015_0	7	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	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												
R5941	015	0	1	31	11	R5941_015_0	7	Non-Preferred Drug	4	100100	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												
R5941	015	0	1	31	11	R5941_015_0	7	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
R5941	015	0	1	31	11	R5941_015_0	7	Select Care Drugs	4	001000	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			0.00	0.00	0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
R5941	015	0	1	31	11	R5941_015_0	7	Select Care Drugs	4	001000	1	2	6	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		
R6694	001	0	1	31	11	R6694_001_0	4	Preferred Generic	3	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R6694	001	0	1	31	11	R6694_001_0	4	Generic	3	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R6694	001	0	1	31	11	R6694_001_0	4	Preferred Brand	3	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					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	001	0	1	31	11	R6694_001_0	4	Non-Preferred Drug	3	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					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	001	0	1	31	11	R6694_001_0	4	Specialty Tier	3	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	27						1.00	27												27						27						27		27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R6694	003	0	1	31	11	R6694_003_0	5	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R6694	003	0	1	31	11	R6694_003_0	5	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	0.00											10.00	20.00	30.00				2.00	4.00	0.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
R6694	003	0	1	31	11	R6694_003_0	5	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R6694	003	0	1	31	11	R6694_003_0	5	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
R6694	003	0	1	31	11	R6694_003_0	5	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R6694	003	0	1	31	11	R6694_003_0	5	Non-Preferred Drug	4	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R6694	003	0	1	31	11	R6694_003_0	5	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R6694	005	0	1	31	11	R6694_005_0	4	Preferred Generic	3	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	4.00											10.00	20.00	30.00				2.00	4.00	4.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R6694	005	0	1	31	11	R6694_005_0	4	Generic	3	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R6694	005	0	1	31	11	R6694_005_0	4	Preferred Brand	3	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R6694	005	0	1	31	11	R6694_005_0	4	Non-Preferred Drug	3	100100	1	2	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								100.00	200.00	300.00					100.00	200.00	300.00											100.00	200.00	300.00				100.00	200.00	300.00					100.00			100.00			3.33	3.33		3.33	3.33	3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R6694	005	0	1	31	11	R6694_005_0	4	Specialty Tier	3	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	28						1.00	28												28						28						28		28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R6801	009	0	1	31	11	R6801_009_0	4	Preferred Generic	4	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	4.00		12.00																											12.00						0.00				4.00				4.00		0.13						0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R6801	009	0	1	31	11	R6801_009_0	4	Generic	4	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	11.00		33.00																											33.00						0.00				11.00				11.00		0.36						0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R6801	009	0	1	31	11	R6801_009_0	4	Preferred Brand	4	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R6801	009	0	1	31	11	R6801_009_0	4	Non-Preferred Drug	4	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R6801	009	0	1	31	11	R6801_009_0	4	Specialty Tier	4	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				1065.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R6801	012	0	1	31	11	R6801_012_0	4	Preferred Generic	3	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R6801	012	0	1	31	11	R6801_012_0	4	Generic	3	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R6801	012	0	1	31	11	R6801_012_0	4	Preferred Brand	3	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R6801	012	0	1	31	11	R6801_012_0	4	Non-Preferred Drug	3	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R6801	012	0	1	31	11	R6801_012_0	4	Specialty Tier	3	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				874.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R7444	001	0	1	31	11	R7444_001_0	6	Preferred Generic	3	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R7444	001	0	1	31	11	R7444_001_0	6	Generic	3	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											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	6	Preferred Brand	3	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		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	6	Non-Preferred Drug	3	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		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	6	Specialty Tier	3	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				634.00	27		27																										27						27			27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R7444	003	0	1	31	11	R7444_003_0	4	Preferred Generic	3	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R7444	003	0	1	31	11	R7444_003_0	4	Generic	3	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R7444	003	0	1	31	11	R7444_003_0	4	Preferred Brand	3	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R7444	003	0	1	31	11	R7444_003_0	4	Non-Preferred Drug	3	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R7444	003	0	1	31	11	R7444_003_0	4	Specialty Tier	3	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				786.00	28		28																										28						28			28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R7444	008	0	1	31	11	R7444_008_0	4	Preferred Generic	3	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	2.00		6.00																											6.00						0.00				2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R7444	008	0	1	31	11	R7444_008_0	4	Generic	3	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R7444	008	0	1	31	11	R7444_008_0	4	Preferred Brand	3	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R7444	008	0	1	31	11	R7444_008_0	4	Non-Preferred Drug	3	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R7444	008	0	1	31	11	R7444_008_0	4	Specialty Tier	3	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				917.00	31		31																										31						31			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R7444	010	0	1	31	11	R7444_010_0	4	Preferred Generic	3	001000	1	2	1	1	110		01		100	1	30		90				1	2						90	30		31	3.00		9.00																											9.00						0.00				3.00				3.00		0.10						0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R7444	010	0	1	31	11	R7444_010_0	4	Generic	3	010000	1	2	2	1	110		01		100	1	30		90				1	2						90	30		31	12.00		36.00																											36.00						0.00				12.00				12.00		0.40						0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R7444	010	0	1	31	11	R7444_010_0	4	Preferred Brand	3	010001	1	2	3	1	110		01		100	1	30		90				1	2						90	30		31	47.00		141.00																											141.00						131.00				47.00				47.00		1.56						1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R7444	010	0	1	31	11	R7444_010_0	4	Non-Preferred Drug	3	100100	1	2	4	1	110		01		100	1	30		90				1	2						90	30		31	100.00		300.00																											300.00						290.00				100.00				100.00		3.33						3.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
R7444	010	0	1	31	11	R7444_010_0	4	Specialty Tier	3	010010	1	1	5	1	110		01		100	1	30		90				1	2						90	30		31				1034.00	29		29																										29						29			29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	001	0		29	10	S0522_001_0	2	Preferred Generic	2	001000	1	2	1	1		110	01		100	1				30		90	1	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												
S0522	001	0		29	10	S0522_001_0	2	Generic	2	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								3.00		9.00					2.00		6.00													9.00						6.00				3.00				3.00			0.10	0.06				0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	001	0		29	10	S0522_001_0	2	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								27.00		81.00					27.00		81.00													81.00						81.00				27.00				27.00			0.90	0.90				0.87	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	001	0		29	10	S0522_001_0	2	Non-Preferred Drug	2	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											64.00	35		35				64.00	35		35												35						35			35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	001	0		29	10	S0522_001_0	2	Specialty Tier	2	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											589.00	25		25				589.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	002	0		29	10	S0522_002_0	1	Preferred Generic	2	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								3.00		9.00					1.00		3.00													9.00						3.00				3.00				3.00			0.10	0.03				0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	002	0		29	10	S0522_002_0	1	Generic	2	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								4.00		12.00					2.00		6.00													12.00						6.00				4.00				4.00			0.13	0.06				0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	002	0		29	10	S0522_002_0	1	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								26.00		78.00					26.00		78.00													78.00						78.00				26.00				26.00			0.86	0.86				0.83	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	002	0		29	10	S0522_002_0	1	Non-Preferred Drug	2	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											51.00	32		32				51.00	32		32												32						32			32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	002	0		29	10	S0522_002_0	1	Specialty Tier	2	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											449.00	25		25				449.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	004	0		29	10	S0522_004_0	2	Preferred Generic	2	001000	1	2	1	1		110	01		100	1				30		90	1	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												
S0522	004	0		29	10	S0522_004_0	2	Generic	2	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								3.00		9.00					2.00		6.00													9.00						6.00				3.00				3.00			0.10	0.06				0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	004	0		29	10	S0522_004_0	2	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								27.00		81.00					27.00		81.00													81.00						81.00				27.00				27.00			0.90	0.90				0.87	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	004	0		29	10	S0522_004_0	2	Non-Preferred Drug	2	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											70.00	35		35				70.00	35		35												35						35			35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	004	0		29	10	S0522_004_0	2	Specialty Tier	2	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											608.00	25		25				608.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	006	0		29	10	S0522_006_0	2	Preferred Generic	2	001000	1	2	1	1		110	01		100	1				30		90	1	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												
S0522	006	0		29	10	S0522_006_0	2	Generic	2	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								3.00		9.00					2.00		6.00													9.00						6.00				3.00				3.00			0.10	0.06				0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	006	0		29	10	S0522_006_0	2	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								26.00		78.00					26.00		78.00													78.00						78.00				26.00				26.00			0.86	0.86				0.83	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	006	0		29	10	S0522_006_0	2	Non-Preferred Drug	2	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											67.00	35		35				67.00	35		35												35						35			35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	006	0		29	10	S0522_006_0	2	Specialty Tier	2	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											595.00	25		25				595.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	008	0		29	10	S0522_008_0	2	Preferred Generic	2	001000	1	2	1	1		110	01		100	1				30		90	1	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												
S0522	008	0		29	10	S0522_008_0	2	Generic	2	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								3.00		9.00					2.00		6.00													9.00						6.00				3.00				3.00			0.10	0.06				0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	008	0		29	10	S0522_008_0	2	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								26.00		78.00					26.00		78.00													78.00						78.00				26.00				26.00			0.86	0.86				0.83	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	008	0		29	10	S0522_008_0	2	Non-Preferred Drug	2	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											60.00	35		35				60.00	35		35												35						35			35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	008	0		29	10	S0522_008_0	2	Specialty Tier	2	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											601.00	25		25				601.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	010	0		29	10	S0522_010_0	2	Preferred Generic	2	001000	1	2	1	1		110	01		100	1				30		90	1	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												
S0522	010	0		29	10	S0522_010_0	2	Generic	2	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								3.00		9.00					2.00		6.00													9.00						6.00				3.00				3.00			0.10	0.06				0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	010	0		29	10	S0522_010_0	2	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								28.00		84.00					28.00		84.00													84.00						84.00				28.00				28.00			0.93	0.93				0.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	010	0		29	10	S0522_010_0	2	Non-Preferred Drug	2	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											67.00	34		34				67.00	34		34												34						34			34			34								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	010	0		29	10	S0522_010_0	2	Specialty Tier	2	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											582.00	25		25				582.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	012	0		29	10	S0522_012_0	2	Preferred Generic	2	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								3.00		9.00					1.00		3.00													9.00						3.00				3.00				3.00			0.10	0.03				0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	012	0		29	10	S0522_012_0	2	Generic	2	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								4.00		12.00					2.00		6.00													12.00						6.00				4.00				4.00			0.13	0.06				0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	012	0		29	10	S0522_012_0	2	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								26.00		78.00					26.00		78.00													78.00						78.00				26.00				26.00			0.86	0.86				0.83	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	012	0		29	10	S0522_012_0	2	Non-Preferred Drug	2	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											60.00	35		35				60.00	35		35												35						35			35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	012	0		29	10	S0522_012_0	2	Specialty Tier	2	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											641.00	25		25				641.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	014	0		29	10	S0522_014_0	2	Preferred Generic	2	001000	1	2	1	1		110	01		100	1				30		90	1	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												
S0522	014	0		29	10	S0522_014_0	2	Generic	2	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								3.00		9.00					2.00		6.00													9.00						6.00				3.00				3.00			0.10	0.06				0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	014	0		29	10	S0522_014_0	2	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								26.00		78.00					26.00		78.00													78.00						78.00				26.00				26.00			0.86	0.86				0.83	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	014	0		29	10	S0522_014_0	2	Non-Preferred Drug	2	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											53.00	35		35				53.00	35		35												35						35			35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	014	0		29	10	S0522_014_0	2	Specialty Tier	2	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											439.00	25		25				439.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	016	0		29	10	S0522_016_0	2	Preferred Generic	2	001000	1	2	1	1		110	01		100	1				30		90	1	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												
S0522	016	0		29	10	S0522_016_0	2	Generic	2	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								3.00		9.00					2.00		6.00													9.00						6.00				3.00				3.00			0.10	0.06				0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	016	0		29	10	S0522_016_0	2	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								24.00		72.00					24.00		72.00													72.00						72.00				24.00				24.00			0.80	0.80				0.77	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	016	0		29	10	S0522_016_0	2	Non-Preferred Drug	2	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											65.00	35		35				65.00	35		35												35						35			35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	016	0		29	10	S0522_016_0	2	Specialty Tier	2	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											603.00	25		25				603.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	018	0		29	10	S0522_018_0	2	Preferred Generic	2	001000	1	2	1	1		110	01		100	1				30		90	1	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												
S0522	018	0		29	10	S0522_018_0	2	Generic	2	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								3.00		9.00					2.00		6.00													9.00						6.00				3.00				3.00			0.10	0.06				0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	018	0		29	10	S0522_018_0	2	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								23.00		69.00					23.00		69.00													69.00						69.00				23.00				23.00			0.76	0.76				0.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	018	0		29	10	S0522_018_0	2	Non-Preferred Drug	2	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											62.00	35		35				62.00	35		35												35						35			35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	018	0		29	10	S0522_018_0	2	Specialty Tier	2	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											539.00	25		25				539.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	020	0		29	10	S0522_020_0	2	Preferred Generic	2	001000	1	2	1	1		110	01		100	1				30		90	1	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												
S0522	020	0		29	10	S0522_020_0	2	Generic	2	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								3.00		9.00					2.00		6.00													9.00						6.00				3.00				3.00			0.10	0.06				0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	020	0		29	10	S0522_020_0	2	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								27.00		81.00					23.00		69.00													81.00						69.00				27.00				27.00			0.90	0.76				0.87	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	020	0		29	10	S0522_020_0	2	Non-Preferred Drug	2	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											63.00	35		35				63.00	35		35												35						35			35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	020	0		29	10	S0522_020_0	2	Specialty Tier	2	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											493.00	25		25				493.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	022	0		29	10	S0522_022_0	2	Preferred Generic	2	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								3.00		9.00					1.00		3.00													9.00						3.00				3.00				3.00			0.10	0.03				0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	022	0		29	10	S0522_022_0	2	Generic	2	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								4.00		12.00					2.00		6.00													12.00						6.00				4.00				4.00			0.13	0.06				0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	022	0		29	10	S0522_022_0	2	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								24.00		72.00					24.00		72.00													72.00						72.00				24.00				24.00			0.80	0.80				0.77	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	022	0		29	10	S0522_022_0	2	Non-Preferred Drug	2	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											60.00	34		34				60.00	34		34												34						34			34			34								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	022	0		29	10	S0522_022_0	2	Specialty Tier	2	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											579.00	25		25				579.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	024	0		29	10	S0522_024_0	2	Preferred Generic	2	001000	1	2	1	1		110	01		100	1				30		90	1	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												
S0522	024	0		29	10	S0522_024_0	2	Generic	2	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								3.00		9.00					2.00		6.00													9.00						6.00				3.00				3.00			0.10	0.06				0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	024	0		29	10	S0522_024_0	2	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								28.00		84.00					25.00		75.00													84.00						75.00				28.00				28.00			0.93	0.83				0.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	024	0		29	10	S0522_024_0	2	Non-Preferred Drug	2	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											58.00	35		35				58.00	35		35												35						35			35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	024	0		29	10	S0522_024_0	2	Specialty Tier	2	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											610.00	25		25				610.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	026	0		29	10	S0522_026_0	2	Preferred Generic	2	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								3.00		9.00					1.00		3.00													9.00						3.00				3.00				3.00			0.10	0.03				0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	026	0		29	10	S0522_026_0	2	Generic	2	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								4.00		12.00					2.00		6.00													12.00						6.00				4.00				4.00			0.13	0.06				0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	026	0		29	10	S0522_026_0	2	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								25.00		75.00					25.00		75.00													75.00						75.00				25.00				25.00			0.83	0.83				0.80	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	026	0		29	10	S0522_026_0	2	Non-Preferred Drug	2	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											61.00	33		33				61.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	026	0		29	10	S0522_026_0	2	Specialty Tier	2	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											575.00	25		25				575.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	028	0		29	10	S0522_028_0	2	Preferred Generic	2	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								3.00		9.00					1.00		3.00													9.00						3.00				3.00				3.00			0.10	0.03				0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	028	0		29	10	S0522_028_0	2	Generic	2	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								4.00		12.00					2.00		6.00													12.00						6.00				4.00				4.00			0.13	0.06				0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	028	0		29	10	S0522_028_0	2	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								28.00		84.00					28.00		84.00													84.00						84.00				28.00				28.00			0.93	0.93				0.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	028	0		29	10	S0522_028_0	2	Non-Preferred Drug	2	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											58.00	35		35				58.00	35		35												35						35			35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	028	0		29	10	S0522_028_0	2	Specialty Tier	2	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											583.00	25		25				583.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	030	0		29	10	S0522_030_0	1	Preferred Generic	2	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								3.00		9.00					1.00		3.00													9.00						3.00				3.00				3.00			0.10	0.03				0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	030	0		29	10	S0522_030_0	1	Generic	2	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								4.00		12.00					2.00		6.00													12.00						6.00				4.00				4.00			0.13	0.06				0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	030	0		29	10	S0522_030_0	1	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								22.00		66.00					22.00		66.00													66.00						66.00				22.00				22.00			0.73	0.73				0.70	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	030	0		29	10	S0522_030_0	1	Non-Preferred Drug	2	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											55.00	35		35				55.00	35		35												35						35			35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	030	0		29	10	S0522_030_0	1	Specialty Tier	2	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											547.00	25		25				547.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	032	0		29	10	S0522_032_0	1	Preferred Generic	2	001000	1	2	1	1		110	01		100	1				30		90	1	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												
S0522	032	0		29	10	S0522_032_0	1	Generic	2	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								3.00		9.00					2.00		6.00													9.00						6.00				3.00				3.00			0.10	0.06				0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	032	0		29	10	S0522_032_0	1	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								23.00		69.00					20.00		60.00													69.00						60.00				23.00				23.00			0.76	0.66				0.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	032	0		29	10	S0522_032_0	1	Non-Preferred Drug	2	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											61.00	35		35				61.00	35		35												35						35			35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	032	0		29	10	S0522_032_0	1	Specialty Tier	2	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											505.00	25		25				505.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	034	0		29	10	S0522_034_0	2	Preferred Generic	2	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								3.00		9.00					1.00		3.00													9.00						3.00				3.00				3.00			0.10	0.03				0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	034	0		29	10	S0522_034_0	2	Generic	2	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								4.00		12.00					2.00		6.00													12.00						6.00				4.00				4.00			0.13	0.06				0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	034	0		29	10	S0522_034_0	2	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								26.00		78.00					26.00		78.00													78.00						78.00				26.00				26.00			0.86	0.86				0.83	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	034	0		29	10	S0522_034_0	2	Non-Preferred Drug	2	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											67.00	33		33				67.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	034	0		29	10	S0522_034_0	2	Specialty Tier	2	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											581.00	25		25				581.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	036	0		29	10	S0522_036_0	2	Preferred Generic	2	001000	1	2	1	1		110	01		100	1				30		90	1	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												
S0522	036	0		29	10	S0522_036_0	2	Generic	2	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								3.00		9.00					2.00		6.00													9.00						6.00				3.00				3.00			0.10	0.06				0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	036	0		29	10	S0522_036_0	2	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								24.00		72.00					24.00		72.00													72.00						72.00				24.00				24.00			0.80	0.80				0.77	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	036	0		29	10	S0522_036_0	2	Non-Preferred Drug	2	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											60.00	35		35				60.00	35		35												35						35			35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	036	0		29	10	S0522_036_0	2	Specialty Tier	2	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											548.00	25		25				548.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	037	0		29	10	S0522_037_0	2	Preferred Generic	2	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								3.00		9.00					1.00		3.00													9.00						3.00				3.00				3.00			0.10	0.03				0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	037	0		29	10	S0522_037_0	2	Generic	2	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								4.00		12.00					2.00		6.00													12.00						6.00				4.00				4.00			0.13	0.06				0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	037	0		29	10	S0522_037_0	2	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								28.00		84.00					28.00		84.00													84.00						84.00				28.00				28.00			0.93	0.93				0.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	037	0		29	10	S0522_037_0	2	Non-Preferred Drug	2	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											61.00	35		35				61.00	35		35												35						35			35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	037	0		29	10	S0522_037_0	2	Specialty Tier	2	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											527.00	25		25				527.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	038	0		29	10	S0522_038_0	2	Preferred Generic	2	001000	1	2	1	1		110	01		100	1				30		90	1	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												
S0522	038	0		29	10	S0522_038_0	2	Generic	2	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								3.00		9.00					2.00		6.00													9.00						6.00				3.00				3.00			0.10	0.06				0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	038	0		29	10	S0522_038_0	2	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								26.00		78.00					26.00		78.00													78.00						78.00				26.00				26.00			0.86	0.86				0.83	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	038	0		29	10	S0522_038_0	2	Non-Preferred Drug	2	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											60.00	35		35				60.00	35		35												35						35			35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	038	0		29	10	S0522_038_0	2	Specialty Tier	2	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											579.00	25		25				579.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	039	0		29	10	S0522_039_0	2	Preferred Generic	2	001000	1	2	1	1		110	01		100	1				30		90	1	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												
S0522	039	0		29	10	S0522_039_0	2	Generic	2	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								3.00		9.00					2.00		6.00													9.00						6.00				3.00				3.00			0.10	0.06				0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	039	0		29	10	S0522_039_0	2	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								27.00		81.00					27.00		81.00													81.00						81.00				27.00				27.00			0.90	0.90				0.87	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	039	0		29	10	S0522_039_0	2	Non-Preferred Drug	2	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											60.00	35		35				60.00	35		35												35						35			35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	039	0		29	10	S0522_039_0	2	Specialty Tier	2	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											664.00	25		25				664.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	040	0		29	10	S0522_040_0	2	Preferred Generic	2	001000	1	2	1	1		110	01		100	1				30		90	1	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												
S0522	040	0		29	10	S0522_040_0	2	Generic	2	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								3.00		9.00					2.00		6.00													9.00						6.00				3.00				3.00			0.10	0.06				0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	040	0		29	10	S0522_040_0	2	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								23.00		69.00					23.00		69.00													69.00						69.00				23.00				23.00			0.76	0.76				0.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	040	0		29	10	S0522_040_0	2	Non-Preferred Drug	2	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											64.00	35		35				64.00	35		35												35						35			35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	040	0		29	10	S0522_040_0	2	Specialty Tier	2	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											562.00	25		25				562.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	041	0		29	10	S0522_041_0	2	Preferred Generic	2	001000	1	2	1	1		110	01		100	1				30		90	1	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												
S0522	041	0		29	10	S0522_041_0	2	Generic	2	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								3.00		9.00					2.00		6.00													9.00						6.00				3.00				3.00			0.10	0.06				0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	041	0		29	10	S0522_041_0	2	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								29.00		87.00					29.00		87.00													87.00						87.00				29.00				29.00			0.96	0.96				0.93	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	041	0		29	10	S0522_041_0	2	Non-Preferred Drug	2	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											55.00	35		35				55.00	35		35												35						35			35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	041	0		29	10	S0522_041_0	2	Specialty Tier	2	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											513.00	25		25				513.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	042	0		29	10	S0522_042_0	2	Preferred Generic	2	001000	1	2	1	1		110	01		100	1				30		90	1	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												
S0522	042	0		29	10	S0522_042_0	2	Generic	2	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								3.00		9.00					2.00		6.00													9.00						6.00				3.00				3.00			0.10	0.06				0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	042	0		29	10	S0522_042_0	2	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								26.00		78.00					26.00		78.00													78.00						78.00				26.00				26.00			0.86	0.86				0.83	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	042	0		29	10	S0522_042_0	2	Non-Preferred Drug	2	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											55.00	35		35				55.00	35		35												35						35			35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	042	0		29	10	S0522_042_0	2	Specialty Tier	2	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											488.00	25		25				488.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	043	0		29	10	S0522_043_0	1	Preferred Generic	2	001000	1	2	1	1		110	01		100	1				30		90	1	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												
S0522	043	0		29	10	S0522_043_0	1	Generic	2	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								3.00		9.00					2.00		6.00													9.00						6.00				3.00				3.00			0.10	0.06				0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	043	0		29	10	S0522_043_0	1	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								24.00		72.00					24.00		72.00													72.00						72.00				24.00				24.00			0.80	0.80				0.77	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	043	0		29	10	S0522_043_0	1	Non-Preferred Drug	2	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											63.00	35		35				63.00	35		35												35						35			35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	043	0		29	10	S0522_043_0	1	Specialty Tier	2	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											601.00	25		25				601.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	044	0		29	10	S0522_044_0	1	Preferred Generic	2	001000	1	2	1	1		110	01		100	1				30		90	1	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												
S0522	044	0		29	10	S0522_044_0	1	Generic	2	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								3.00		9.00					2.00		6.00													9.00						6.00				3.00				3.00			0.10	0.06				0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	044	0		29	10	S0522_044_0	1	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								23.00		69.00					23.00		69.00													69.00						69.00				23.00				23.00			0.76	0.76				0.74	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	044	0		29	10	S0522_044_0	1	Non-Preferred Drug	2	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											61.00	35		35				61.00	35		35												35						35			35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	044	0		29	10	S0522_044_0	1	Specialty Tier	2	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											554.00	25		25				554.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	045	0		29	10	S0522_045_0	2	Preferred Generic	2	001000	1	2	1	1		110	01		100	1				30		90	1	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												
S0522	045	0		29	10	S0522_045_0	2	Generic	2	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								3.00		9.00					2.00		6.00													9.00						6.00				3.00				3.00			0.10	0.06				0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	045	0		29	10	S0522_045_0	2	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								26.00		78.00					26.00		78.00													78.00						78.00				26.00				26.00			0.86	0.86				0.83	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	045	0		29	10	S0522_045_0	2	Non-Preferred Drug	2	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											67.00	35		35				67.00	35		35												35						35			35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	045	0		29	10	S0522_045_0	2	Specialty Tier	2	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											575.00	25		25				575.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	046	0		29	10	S0522_046_0	1	Preferred Generic	2	001000	1	2	1	1		110	01		100	1				30		90	1	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												
S0522	046	0		29	10	S0522_046_0	1	Generic	2	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								3.00		9.00					2.00		6.00													9.00						6.00				3.00				3.00			0.10	0.06				0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	046	0		29	10	S0522_046_0	1	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								28.00		84.00					28.00		84.00													84.00						84.00				28.00				28.00			0.93	0.93				0.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	046	0		29	10	S0522_046_0	1	Non-Preferred Drug	2	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											69.00	35		35				69.00	35		35												35						35			35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	046	0		29	10	S0522_046_0	1	Specialty Tier	2	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											531.00	25		25				531.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	047	0		29	10	S0522_047_0	2	Preferred Generic	2	001000	1	2	1	1		110	01		100	1				30		90	1	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												
S0522	047	0		29	10	S0522_047_0	2	Generic	2	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								3.00		9.00					2.00		6.00													9.00						6.00				3.00				3.00			0.10	0.06				0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	047	0		29	10	S0522_047_0	2	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								25.00		75.00					25.00		75.00													75.00						75.00				25.00				25.00			0.83	0.83				0.80	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	047	0		29	10	S0522_047_0	2	Non-Preferred Drug	2	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											56.00	35		35				56.00	35		35												35						35			35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	047	0		29	10	S0522_047_0	2	Specialty Tier	2	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											570.00	25		25				570.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	048	0		29	10	S0522_048_0	4	Preferred Generic	4	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	048	0		29	10	S0522_048_0	4	Generic	4	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								18.00		54.00					3.00		9.00													54.00						9.00				18.00				18.00			0.60	0.10				0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	048	0		29	10	S0522_048_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					27.00		81.00													141.00						81.00				47.00				47.00			1.56	0.90				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	048	0		29	10	S0522_048_0	4	Non-Preferred Drug	4	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											94.00	33		33				91.00	32		32												33						32			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	048	0		29	10	S0522_048_0	4	Specialty Tier	4	010001	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											759.00	25		25				759.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	049	0		29	10	S0522_049_0	4	Preferred Generic	4	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	049	0		29	10	S0522_049_0	4	Generic	4	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								18.00		54.00					3.00		9.00													54.00						9.00				18.00				18.00			0.60	0.10				0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	049	0		29	10	S0522_049_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					27.00		81.00													141.00						81.00				47.00				47.00			1.56	0.90				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	049	0		29	10	S0522_049_0	4	Non-Preferred Drug	4	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											94.00	33		33				91.00	32		32												33						32			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	049	0		29	10	S0522_049_0	4	Specialty Tier	4	010001	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											763.00	25		25				763.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	050	0		29	10	S0522_050_0	4	Preferred Generic	4	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	050	0		29	10	S0522_050_0	4	Generic	4	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								18.00		54.00					3.00		9.00													54.00						9.00				18.00				18.00			0.60	0.10				0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	050	0		29	10	S0522_050_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					27.00		81.00													141.00						81.00				47.00				47.00			1.56	0.90				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	050	0		29	10	S0522_050_0	4	Non-Preferred Drug	4	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											94.00	33		33				91.00	32		32												33						32			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	050	0		29	10	S0522_050_0	4	Specialty Tier	4	010001	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											759.00	25		25				759.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	051	0		29	10	S0522_051_0	4	Preferred Generic	4	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	051	0		29	10	S0522_051_0	4	Generic	4	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								18.00		54.00					3.00		9.00													54.00						9.00				18.00				18.00			0.60	0.10				0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	051	0		29	10	S0522_051_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					27.00		81.00													141.00						81.00				47.00				47.00			1.56	0.90				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	051	0		29	10	S0522_051_0	4	Non-Preferred Drug	4	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											93.00	33		33				90.00	32		32												33						32			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	051	0		29	10	S0522_051_0	4	Specialty Tier	4	010001	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											758.00	25		25				758.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	052	0		29	10	S0522_052_0	4	Preferred Generic	4	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	052	0		29	10	S0522_052_0	4	Generic	4	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								18.00		54.00					3.00		9.00													54.00						9.00				18.00				18.00			0.60	0.10				0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	052	0		29	10	S0522_052_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					27.00		81.00													141.00						81.00				47.00				47.00			1.56	0.90				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	052	0		29	10	S0522_052_0	4	Non-Preferred Drug	4	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											94.00	33		33				91.00	32		32												33						32			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	052	0		29	10	S0522_052_0	4	Specialty Tier	4	010001	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											759.00	25		25				759.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	053	0		29	10	S0522_053_0	4	Preferred Generic	4	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	053	0		29	10	S0522_053_0	4	Generic	4	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								18.00		54.00					3.00		9.00													54.00						9.00				18.00				18.00			0.60	0.10				0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	053	0		29	10	S0522_053_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					27.00		81.00													141.00						81.00				47.00				47.00			1.56	0.90				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	053	0		29	10	S0522_053_0	4	Non-Preferred Drug	4	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											94.00	33		33				91.00	32		32												33						32			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	053	0		29	10	S0522_053_0	4	Specialty Tier	4	010001	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											762.00	25		25				762.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	054	0		29	10	S0522_054_0	4	Preferred Generic	4	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	054	0		29	10	S0522_054_0	4	Generic	4	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								18.00		54.00					3.00		9.00													54.00						9.00				18.00				18.00			0.60	0.10				0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	054	0		29	10	S0522_054_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					27.00		81.00													141.00						81.00				47.00				47.00			1.56	0.90				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	054	0		29	10	S0522_054_0	4	Non-Preferred Drug	4	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											93.00	33		33				91.00	32		32												33						32			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	054	0		29	10	S0522_054_0	4	Specialty Tier	4	010001	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											758.00	25		25				758.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	055	0		29	10	S0522_055_0	4	Preferred Generic	4	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	055	0		29	10	S0522_055_0	4	Generic	4	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								18.00		54.00					3.00		9.00													54.00						9.00				18.00				18.00			0.60	0.10				0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	055	0		29	10	S0522_055_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					27.00		81.00													141.00						81.00				47.00				47.00			1.56	0.90				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	055	0		29	10	S0522_055_0	4	Non-Preferred Drug	4	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											93.00	33		33				90.00	32		32												33						32			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	055	0		29	10	S0522_055_0	4	Specialty Tier	4	010001	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											757.00	25		25				757.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	056	0		29	10	S0522_056_0	4	Preferred Generic	4	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	056	0		29	10	S0522_056_0	4	Generic	4	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								18.00		54.00					3.00		9.00													54.00						9.00				18.00				18.00			0.60	0.10				0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	056	0		29	10	S0522_056_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					27.00		81.00													141.00						81.00				47.00				47.00			1.56	0.90				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	056	0		29	10	S0522_056_0	4	Non-Preferred Drug	4	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											94.00	33		33				91.00	32		32												33						32			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	056	0		29	10	S0522_056_0	4	Specialty Tier	4	010001	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											763.00	25		25				763.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	057	0		29	10	S0522_057_0	4	Preferred Generic	4	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	057	0		29	10	S0522_057_0	4	Generic	4	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								18.00		54.00					3.00		9.00													54.00						9.00				18.00				18.00			0.60	0.10				0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	057	0		29	10	S0522_057_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					27.00		81.00													141.00						81.00				47.00				47.00			1.56	0.90				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	057	0		29	10	S0522_057_0	4	Non-Preferred Drug	4	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											95.00	33		33				92.00	32		32												33						32			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	057	0		29	10	S0522_057_0	4	Specialty Tier	4	010001	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											770.00	25		25				770.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	058	0		29	10	S0522_058_0	4	Preferred Generic	4	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	058	0		29	10	S0522_058_0	4	Generic	4	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								18.00		54.00					3.00		9.00													54.00						9.00				18.00				18.00			0.60	0.10				0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	058	0		29	10	S0522_058_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					27.00		81.00													141.00						81.00				47.00				47.00			1.56	0.90				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	058	0		29	10	S0522_058_0	4	Non-Preferred Drug	4	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											94.00	33		33				91.00	32		32												33						32			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	058	0		29	10	S0522_058_0	4	Specialty Tier	4	010001	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											764.00	25		25				764.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	059	0		29	10	S0522_059_0	4	Preferred Generic	4	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	059	0		29	10	S0522_059_0	4	Generic	4	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								18.00		54.00					3.00		9.00													54.00						9.00				18.00				18.00			0.60	0.10				0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	059	0		29	10	S0522_059_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					27.00		81.00													141.00						81.00				47.00				47.00			1.56	0.90				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	059	0		29	10	S0522_059_0	4	Non-Preferred Drug	4	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											94.00	33		33				91.00	32		32												33						32			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	059	0		29	10	S0522_059_0	4	Specialty Tier	4	010001	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											762.00	25		25				762.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	060	0		29	10	S0522_060_0	4	Preferred Generic	4	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	060	0		29	10	S0522_060_0	4	Generic	4	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								18.00		54.00					3.00		9.00													54.00						9.00				18.00				18.00			0.60	0.10				0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	060	0		29	10	S0522_060_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					27.00		81.00													141.00						81.00				47.00				47.00			1.56	0.90				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	060	0		29	10	S0522_060_0	4	Non-Preferred Drug	4	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											93.00	33		33				91.00	32		32												33						32			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	060	0		29	10	S0522_060_0	4	Specialty Tier	4	010001	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											761.00	25		25				761.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	061	0		29	10	S0522_061_0	4	Preferred Generic	4	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	061	0		29	10	S0522_061_0	4	Generic	4	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								18.00		54.00					3.00		9.00													54.00						9.00				18.00				18.00			0.60	0.10				0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	061	0		29	10	S0522_061_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					27.00		81.00													141.00						81.00				47.00				47.00			1.56	0.90				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	061	0		29	10	S0522_061_0	4	Non-Preferred Drug	4	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											93.00	33		33				91.00	32		32												33						32			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	061	0		29	10	S0522_061_0	4	Specialty Tier	4	010001	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											762.00	25		25				762.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	062	0		29	10	S0522_062_0	4	Preferred Generic	4	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	062	0		29	10	S0522_062_0	4	Generic	4	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								18.00		54.00					3.00		9.00													54.00						9.00				18.00				18.00			0.60	0.10				0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	062	0		29	10	S0522_062_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					27.00		81.00													141.00						81.00				47.00				47.00			1.56	0.90				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	062	0		29	10	S0522_062_0	4	Non-Preferred Drug	4	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											93.00	33		33				90.00	32		32												33						32			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	062	0		29	10	S0522_062_0	4	Specialty Tier	4	010001	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											757.00	25		25				757.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	063	0		29	10	S0522_063_0	4	Preferred Generic	4	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	063	0		29	10	S0522_063_0	4	Generic	4	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								18.00		54.00					3.00		9.00													54.00						9.00				18.00				18.00			0.60	0.10				0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	063	0		29	10	S0522_063_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					27.00		81.00													141.00						81.00				47.00				47.00			1.56	0.90				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	063	0		29	10	S0522_063_0	4	Non-Preferred Drug	4	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											94.00	33		33				91.00	32		32												33						32			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	063	0		29	10	S0522_063_0	4	Specialty Tier	4	010001	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											759.00	25		25				759.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	064	0		29	10	S0522_064_0	4	Preferred Generic	4	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	064	0		29	10	S0522_064_0	4	Generic	4	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								18.00		54.00					3.00		9.00													54.00						9.00				18.00				18.00			0.60	0.10				0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	064	0		29	10	S0522_064_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					27.00		81.00													141.00						81.00				47.00				47.00			1.56	0.90				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	064	0		29	10	S0522_064_0	4	Non-Preferred Drug	4	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											93.00	33		33				90.00	32		32												33						32			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	064	0		29	10	S0522_064_0	4	Specialty Tier	4	010001	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											757.00	25		25				757.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	065	0		29	10	S0522_065_0	4	Preferred Generic	4	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	065	0		29	10	S0522_065_0	4	Generic	4	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								18.00		54.00					3.00		9.00													54.00						9.00				18.00				18.00			0.60	0.10				0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	065	0		29	10	S0522_065_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					27.00		81.00													141.00						81.00				47.00				47.00			1.56	0.90				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	065	0		29	10	S0522_065_0	4	Non-Preferred Drug	4	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											93.00	33		33				90.00	32		32												33						32			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	065	0		29	10	S0522_065_0	4	Specialty Tier	4	010001	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											757.00	25		25				757.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	066	0		29	10	S0522_066_0	4	Preferred Generic	4	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	066	0		29	10	S0522_066_0	4	Generic	4	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								18.00		54.00					3.00		9.00													54.00						9.00				18.00				18.00			0.60	0.10				0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	066	0		29	10	S0522_066_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					27.00		81.00													141.00						81.00				47.00				47.00			1.56	0.90				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	066	0		29	10	S0522_066_0	4	Non-Preferred Drug	4	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											93.00	33		33				91.00	32		32												33						32			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	066	0		29	10	S0522_066_0	4	Specialty Tier	4	010001	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											758.00	25		25				758.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	067	0		29	10	S0522_067_0	4	Preferred Generic	4	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	067	0		29	10	S0522_067_0	4	Generic	4	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								18.00		54.00					3.00		9.00													54.00						9.00				18.00				18.00			0.60	0.10				0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	067	0		29	10	S0522_067_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					27.00		81.00													141.00						81.00				47.00				47.00			1.56	0.90				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	067	0		29	10	S0522_067_0	4	Non-Preferred Drug	4	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											93.00	33		33				91.00	32		32												33						32			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	067	0		29	10	S0522_067_0	4	Specialty Tier	4	010001	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											758.00	25		25				758.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	068	0		29	10	S0522_068_0	4	Preferred Generic	4	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	068	0		29	10	S0522_068_0	4	Generic	4	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								18.00		54.00					3.00		9.00													54.00						9.00				18.00				18.00			0.60	0.10				0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	068	0		29	10	S0522_068_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					27.00		81.00													141.00						81.00				47.00				47.00			1.56	0.90				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	068	0		29	10	S0522_068_0	4	Non-Preferred Drug	4	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											93.00	33		33				91.00	32		32												33						32			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	068	0		29	10	S0522_068_0	4	Specialty Tier	4	010001	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											757.00	25		25				757.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	069	0		29	10	S0522_069_0	4	Preferred Generic	4	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	069	0		29	10	S0522_069_0	4	Generic	4	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								18.00		54.00					3.00		9.00													54.00						9.00				18.00				18.00			0.60	0.10				0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	069	0		29	10	S0522_069_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					27.00		81.00													141.00						81.00				47.00				47.00			1.56	0.90				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	069	0		29	10	S0522_069_0	4	Non-Preferred Drug	4	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											94.00	33		33				91.00	32		32												33						32			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	069	0		29	10	S0522_069_0	4	Specialty Tier	4	010001	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											761.00	25		25				761.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	070	0		29	10	S0522_070_0	4	Preferred Generic	4	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	070	0		29	10	S0522_070_0	4	Generic	4	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								18.00		54.00					3.00		9.00													54.00						9.00				18.00				18.00			0.60	0.10				0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	070	0		29	10	S0522_070_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					27.00		81.00													141.00						81.00				47.00				47.00			1.56	0.90				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	070	0		29	10	S0522_070_0	4	Non-Preferred Drug	4	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											94.00	33		33				91.00	32		32												33						32			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	070	0		29	10	S0522_070_0	4	Specialty Tier	4	010001	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											766.00	25		25				766.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	071	0		29	10	S0522_071_0	4	Preferred Generic	4	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	071	0		29	10	S0522_071_0	4	Generic	4	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								18.00		54.00					3.00		9.00													54.00						9.00				18.00				18.00			0.60	0.10				0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	071	0		29	10	S0522_071_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					27.00		81.00													141.00						81.00				47.00				47.00			1.56	0.90				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	071	0		29	10	S0522_071_0	4	Non-Preferred Drug	4	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											93.00	33		33				90.00	32		32												33						32			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	071	0		29	10	S0522_071_0	4	Specialty Tier	4	010001	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											754.00	25		25				754.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	072	0		29	10	S0522_072_0	4	Preferred Generic	4	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	072	0		29	10	S0522_072_0	4	Generic	4	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								18.00		54.00					3.00		9.00													54.00						9.00				18.00				18.00			0.60	0.10				0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	072	0		29	10	S0522_072_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					27.00		81.00													141.00						81.00				47.00				47.00			1.56	0.90				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	072	0		29	10	S0522_072_0	4	Non-Preferred Drug	4	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											93.00	33		33				90.00	32		32												33						32			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	072	0		29	10	S0522_072_0	4	Specialty Tier	4	010001	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											755.00	25		25				755.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	073	0		29	10	S0522_073_0	4	Preferred Generic	4	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	073	0		29	10	S0522_073_0	4	Generic	4	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								18.00		54.00					3.00		9.00													54.00						9.00				18.00				18.00			0.60	0.10				0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	073	0		29	10	S0522_073_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					27.00		81.00													141.00						81.00				47.00				47.00			1.56	0.90				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	073	0		29	10	S0522_073_0	4	Non-Preferred Drug	4	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											94.00	33		33				91.00	32		32												33						32			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	073	0		29	10	S0522_073_0	4	Specialty Tier	4	010001	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											758.00	25		25				758.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	074	0		29	10	S0522_074_0	4	Preferred Generic	4	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	074	0		29	10	S0522_074_0	4	Generic	4	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								18.00		54.00					3.00		9.00													54.00						9.00				18.00				18.00			0.60	0.10				0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	074	0		29	10	S0522_074_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					27.00		81.00													141.00						81.00				47.00				47.00			1.56	0.90				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	074	0		29	10	S0522_074_0	4	Non-Preferred Drug	4	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											94.00	33		33				91.00	32		32												33						32			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	074	0		29	10	S0522_074_0	4	Specialty Tier	4	010001	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											762.00	25		25				762.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	075	0		29	10	S0522_075_0	4	Preferred Generic	4	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	075	0		29	10	S0522_075_0	4	Generic	4	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								18.00		54.00					3.00		9.00													54.00						9.00				18.00				18.00			0.60	0.10				0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	075	0		29	10	S0522_075_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					27.00		81.00													141.00						81.00				47.00				47.00			1.56	0.90				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	075	0		29	10	S0522_075_0	4	Non-Preferred Drug	4	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											93.00	33		33				90.00	32		32												33						32			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	075	0		29	10	S0522_075_0	4	Specialty Tier	4	010001	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											756.00	25		25				756.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	076	0		29	10	S0522_076_0	4	Preferred Generic	4	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	076	0		29	10	S0522_076_0	4	Generic	4	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								18.00		54.00					3.00		9.00													54.00						9.00				18.00				18.00			0.60	0.10				0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	076	0		29	10	S0522_076_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					27.00		81.00													141.00						81.00				47.00				47.00			1.56	0.90				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	076	0		29	10	S0522_076_0	4	Non-Preferred Drug	4	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											93.00	33		33				91.00	32		32												33						32			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	076	0		29	10	S0522_076_0	4	Specialty Tier	4	010001	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											757.00	25		25				757.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	077	0		29	10	S0522_077_0	4	Preferred Generic	4	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	077	0		29	10	S0522_077_0	4	Generic	4	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								18.00		54.00					3.00		9.00													54.00						9.00				18.00				18.00			0.60	0.10				0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	077	0		29	10	S0522_077_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					27.00		81.00													141.00						81.00				47.00				47.00			1.56	0.90				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	077	0		29	10	S0522_077_0	4	Non-Preferred Drug	4	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											93.00	33		33				91.00	32		32												33						32			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	077	0		29	10	S0522_077_0	4	Specialty Tier	4	010001	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											757.00	25		25				757.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	078	0		29	10	S0522_078_0	1	Preferred Generic	2	001000	1	2	1	1		110	01		100	1				30		90	1	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												
S0522	078	0		29	10	S0522_078_0	1	Generic	2	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								3.00		9.00					2.00		6.00													9.00						6.00				3.00				3.00			0.10	0.06				0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	078	0		29	10	S0522_078_0	1	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								26.00		78.00					26.00		78.00													78.00						78.00				26.00				26.00			0.86	0.86				0.83	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	078	0		29	10	S0522_078_0	1	Non-Preferred Drug	2	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											62.00	35		35				62.00	35		35												35						35			35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	078	0		29	10	S0522_078_0	1	Specialty Tier	2	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											546.00	25		25				546.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	079	0		29	10	S0522_079_0	1	Preferred Generic	2	001000	1	2	1	1		110	01		100	1				30		90	1	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												
S0522	079	0		29	10	S0522_079_0	1	Generic	2	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								3.00		9.00					2.00		6.00													9.00						6.00				3.00				3.00			0.10	0.06				0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	079	0		29	10	S0522_079_0	1	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								26.00		78.00					26.00		78.00													78.00						78.00				26.00				26.00			0.86	0.86				0.83	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	079	0		29	10	S0522_079_0	1	Non-Preferred Drug	2	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											62.00	35		35				62.00	35		35												35						35			35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	079	0		29	10	S0522_079_0	1	Specialty Tier	2	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											550.00	25		25				550.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	080	0		29	10	S0522_080_0	4	Preferred Generic	4	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	080	0		29	10	S0522_080_0	4	Generic	4	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								18.00		54.00					3.00		9.00													54.00						9.00				18.00				18.00			0.60	0.10				0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	080	0		29	10	S0522_080_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					27.00		81.00													141.00						81.00				47.00				47.00			1.56	0.90				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	080	0		29	10	S0522_080_0	4	Non-Preferred Drug	4	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											94.00	33		33				91.00	32		32												33						32			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	080	0		29	10	S0522_080_0	4	Specialty Tier	4	010001	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											759.00	25		25				759.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	081	0		29	10	S0522_081_0	4	Preferred Generic	4	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	081	0		29	10	S0522_081_0	4	Generic	4	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								18.00		54.00					3.00		9.00													54.00						9.00				18.00				18.00			0.60	0.10				0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	081	0		29	10	S0522_081_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					27.00		81.00													141.00						81.00				47.00				47.00			1.56	0.90				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	081	0		29	10	S0522_081_0	4	Non-Preferred Drug	4	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											94.00	33		33				91.00	32		32												33						32			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S0522	081	0		29	10	S0522_081_0	4	Specialty Tier	4	010001	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											762.00	25		25				762.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S1030	001	0		29	10	S1030_001_0	3	Preferred Generic	4	001000	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								12.00		36.00					2.00		4.00					2.00		4.00																12.00				12.00			0.40	0.06	0.06			0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S1030	001	0		29	10	S1030_001_0	3	Generic	4	010000	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								18.00		54.00					8.00		16.00					8.00		16.00																18.00				18.00			0.60	0.26	0.26			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S1030	001	0		29	10	S1030_001_0	3	Preferred Brand	4	010001	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		141.00					37.00		74.00					37.00		74.00																47.00				47.00			1.56	1.23	1.23			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S1030	001	0		29	10	S1030_001_0	3	Non-Preferred Brand	4	110000	1	1	4	1		110	01	110		1				30		90	1	2	30		90				30		31											65.00	50		50				51.00	40		40				40		40															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S1030	001	0		29	10	S1030_001_0	3	Specialty Tier	4	010010	1	1	5	1		110	01	110		1				30		90	1	2	30		90				30		31											1.00	33		33				1.00	33		33				33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S1030	006	0		29	10	S1030_006_0	2	Preferred Generic	3	001000	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								15.00		45.00					5.00		10.00					5.00		10.00																15.00				15.00			0.50	0.16	0.16			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S1030	006	0		29	10	S1030_006_0	2	Generic	3	010000	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								20.00		60.00					10.00		20.00					10.00		20.00																20.00				20.00			0.66	0.33	0.33			0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S1030	006	0		29	10	S1030_006_0	2	Preferred Brand	3	010001	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		141.00					37.00		74.00					37.00		74.00																47.00				47.00			1.56	1.23	1.23			1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S1030	006	0		29	10	S1030_006_0	2	Non-Preferred Brand	3	110000	1	1	4	1		110	01	110		1				30		90	1	2	30		90				30		31											63.00	50		50				50.00	40		40				40		40															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S1030	006	0		29	10	S1030_006_0	2	Specialty Tier	3	010010	1	1	5	1		110	01	110		1				30		90	1	2	30		90				30		31											1.00	26		26				1.00	26		26				26		26															26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2468	003	0		29	10	S2468_003_0	2	Preferred Generic	3	001010	1	2	1	1		111	01	100		1				30	60	90	1	2			90				30		31								8.00	16.00	24.00					2.00	4.00	4.00							4.00																8.00				8.00			0.27	0.07				0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S2468	003	0		29	10	S2468_003_0	2	Generic	3	010010	1	2	2	1		111	01	100		1				30	60	90	2	2			90				30		31								14.00	28.00	42.00					6.00	12.00	12.00							12.00																14.00				14.00			0.47	0.20				0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S2468	003	0		29	10	S2468_003_0	2	Preferred Brand	3	010001	1	2	3	1		111	01	100		1				30	60	90	2	2			90				30		31								47.00	94.00	141.00					40.00	80.00	80.00							80.00																47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S2468	003	0		29	10	S2468_003_0	2	Non-Preferred Brand	3	110000	1	1	4	1		111	01	100		1				30	60	90	2	2			90				30		31											97.78	30	30	30				97.78	28	28	28						28															30			30								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S2468	003	0		29	10	S2468_003_0	2	Injectable Drugs	3	010010	1	1	5	1		111	01	100		1				30	60	90	2	2			90				30		31											124.57	25	25	25				124.57	25	25	25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S2468	003	0		29	10	S2468_003_0	2	Specialty Tier	3	010010	1	1	6	1		010	01	010		1				30					30						30		31												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S2468	004	0		29	10	S2468_004_0	3	Preferred Generic	4	001010	1	2	1	1		111	01	100		1				30	60	90	1	2			90				30		31								13.00	26.00	39.00					4.00	8.00	8.00							8.00																13.00				13.00			0.43	0.13				0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S2468	004	0		29	10	S2468_004_0	3	Generic	4	010010	1	2	2	1		111	01	100		1				30	60	90	2	2			90				30		31								17.00	34.00	51.00					10.00	20.00	20.00							20.00																17.00				17.00			0.57	0.33				0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S2468	004	0		29	10	S2468_004_0	3	Preferred Brand	4	010001	1	2	3	1		111	01	100		1				30	60	90	2	2			90				30		31								47.00	94.00	141.00					40.00	80.00	80.00							80.00																47.00				47.00			1.57	1.33				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S2468	004	0		29	10	S2468_004_0	3	Non-Preferred Brand	4	110000	1	1	4	1		111	01	100		1				30	60	90	2	2			90				30		31											98.63	29	29	29				98.63	27	27	27						27															29			29								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S2468	004	0		29	10	S2468_004_0	3	Injectable Drugs	4	010010	1	1	5	1		111	01	100		1				30	60	90	2	2			90				30		31											118.24	25	25	25				118.24	25	25	25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S2468	004	0		29	10	S2468_004_0	3	Specialty Tier	4	010010	1	1	6	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Injectable Drugs, Specialty Tier												
S2668	005	0		29	10	S2668_005_0	2	Preferred Generic	2	001000	1	2	1	1	111		01	110		1	30	60	90				1	2	30		90				30		31	1.00	2.00	3.00																			1.00		3.00																1.00				1.00		0.03			0.03			0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2668	005	0		29	10	S2668_005_0	2	Generic	2	010000	1	2	2	1	111		01	110		1	30	60	90				1	2	30		90				30		31	5.00	10.00	15.00																			5.00		15.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2668	005	0		29	10	S2668_005_0	2	Preferred Brand	2	000001	1	2	3	1	111		01	110		1	30	60	90				1	2	30		90				30		31	45.00	90.00	135.00																			45.00		135.00																45.00				45.00		1.50			1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2668	005	0		29	10	S2668_005_0	2	Non-Preferred Brand	2	100100	1	1	4	1	111		01	110		1	30	60	90				1	2	30		90				30		31				52.09	40	40	40																		40		40															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2668	005	0		29	10	S2668_005_0	2	Specialty Tier	2	010010	1	1	5	1	111		01	110		1	30	60	90				1	2	30		90				30		31				197.08	25	25	25																		25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2668	006	0		29	10	S2668_006_0	2	Preferred Generic	4	001000	1	2	1	1	111		01	110		1	30	60	90				1	2	30		90				30		31	1.00	2.00	3.00																			1.00		3.00																1.00				1.00		0.03			0.03			0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2668	006	0		29	10	S2668_006_0	2	Generic	4	010000	1	2	2	1	111		01	110		1	30	60	90				1	2	30		90				30		31	4.00	8.00	12.00																			4.00		12.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2668	006	0		29	10	S2668_006_0	2	Preferred Brand	4	000001	1	2	3	1	111		01	110		1	30	60	90				1	2	30		90				30		31	35.00	70.00	105.00																			35.00		105.00																35.00				35.00		1.17			1.17			1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2668	006	0		29	10	S2668_006_0	2	Non-Preferred Brand	4	100100	1	1	4	1	111		01	110		1	30	60	90				1	2	30		90				30		31				41.78	35	35	35																		35		35															35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2668	006	0		29	10	S2668_006_0	2	Specialty Tier	4	010010	1	1	5	1	111		01	110		1	30	60	90				1	2	30		90				30		31				287.02	33	33	33																		33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S2874	001	0		29	10	S2874_001_0	2	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2874	001	0		29	10	S2874_001_0	2	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2874	001	0		29	10	S2874_001_0	2	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2874	001	0		29	10	S2874_001_0	2	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S2874	001	0		29	10	S2874_001_0	2	Non-Preferred Drug	4	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											64.00	50		50				55.00	44		44										50		50				44		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2874	001	0		29	10	S2874_001_0	2	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.17	3.13		3.17	3.13	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S2874	001	0		29	10	S2874_001_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2874	004	0		29	10	S2874_004_0	2	Preferred Generic	2	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0		0.07	0	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2874	004	0		29	10	S2874_004_0	2	Generic	2	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								4.00		12.00					1.00		3.00											4.00		12.00				1.00		0.00				4.00				4.00			0.13	0.03		0.13	0.03	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2874	004	0		29	10	S2874_004_0	2	Preferred Brand	2	010001	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											19.00	25		25				15.00	20		20										25		25				20		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2874	004	0		29	10	S2874_004_0	2	Non-Preferred Drug	2	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											59.00	49		49				41.00	35		35										49		49				35		30			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2874	004	0		29	10	S2874_004_0	2	Specialty Tier	2	010010	1	1	5	1		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	6	Preferred Generic	3	001001	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	24.00					3.00	6.00	9.00					3.00	3.00	3.00																8.00				8.00			0.27	0.10	0.10			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2893	001	0		29	10	S2893_001_0	6	Generic	3	010001	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								20.00	40.00	60.00					8.00	16.00	24.00					8.00	16.00	16.00																20.00				20.00			0.67	0.27	0.27			0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2893	001	0		29	10	S2893_001_0	6	Preferred Brand	3	000101	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								45.00	90.00	135.00					35.00	70.00	105.00					35.00	70.00	70.00																45.00				45.00			1.50	1.17	1.17			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2893	001	0		29	10	S2893_001_0	6	Non-Preferred Drug	3	100100	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											65.52	50	50	50				49.87	40	40	40				40	40	40															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2893	001	0		29	10	S2893_001_0	6	Specialty Tier	3	010010	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												
S2893	003	0		29	10	S2893_003_0	5	Preferred Generic	4	001001	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	27.00					4.00	8.00	12.00					4.00	4.00	4.00																9.00				9.00			0.30	0.13	0.13			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2893	003	0		29	10	S2893_003_0	5	Preferred Generic	4	001001	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								9.00	18.00	27.00					4.00	8.00	12.00					4.00	4.00	4.00																9.00				9.00			0.30	0.13	0.13			0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S2893	003	0		29	10	S2893_003_0	5	Generic	4	010001	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								14.00	28.00	42.00					9.00	18.00	27.00					9.00	18.00	18.00																14.00				14.00			0.47	0.30	0.30			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2893	003	0		29	10	S2893_003_0	5	Generic	4	010001	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								14.00	28.00	42.00					9.00	18.00	27.00					9.00	18.00	18.00																14.00				14.00			0.47	0.30	0.30			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S2893	003	0		29	10	S2893_003_0	5	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								40.00	80.00	120.00					30.00	60.00	90.00					30.00	60.00	60.00																40.00				40.00			1.33	1.00	1.00			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2893	003	0		29	10	S2893_003_0	5	Non-Preferred Drug	4	100100	1	2	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								80.00	160.00	240.00					70.00	140.00	210.00					70.00	140.00	140.00																80.00				80.00			2.67	2.33	2.33			2.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S2893	003	0		29	10	S2893_003_0	5	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		31												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4054	001	0		29	10	S4054_001_0	3	Preferred Generic	2	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	3.00		7.50																					6.00																3.00				3.00		0.10						0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4054	001	0		29	10	S4054_001_0	3	Generic	2	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	8.00		20.00																					16.00																8.00				8.00		.27						0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4054	001	0		29	10	S4054_001_0	3	Preferred Brand	2	000001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	45.00		112.50																					90.00																45.00				45.00		1.50						1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4054	001	0		29	10	S4054_001_0	3	Non-Preferred Brand	2	100000	1	2	4	1	110		01	100		1	30		90				1	2			90				30		31	90.00		220.00																					180.00																90.00				90.00		3.00						2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4054	001	0		29	10	S4054_001_0	3	Specialty Tier	2	001110	1	1	5	1	010		01	010		1	30								30						30		31				200.00	25																				25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	001	0		29	10	S4607_001_0	3	Preferred Generic	2	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	24.00					1.00	2.00	3.00					1.00	2.00	3.00																8.00				8.00			0.27	0.03	0.03			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	001	0		29	10	S4607_001_0	3	Generic	2	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	36.00					5.00	10.00	15.00					5.00	10.00	15.00																12.00				12.00			0.40	0.17	0.17			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	001	0		29	10	S4607_001_0	3	Preferred Brand	2	000001	1	2	3	1		111	01	111		1				30	60	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 Brand, Specialty Tier												
S4607	001	0		29	10	S4607_001_0	3	Non-Preferred Brand	2	100100	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											52.99	50	50	50				49.05	50	50	50				50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	001	0		29	10	S4607_001_0	3	Specialty Tier	2	010010	1	1	5	1		010	01	010		1				30					30						30		31											508.71	25						503.93	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	002	0		29	10	S4607_002_0	1	Preferred Generic	2	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	24.00					1.00	2.00	3.00					1.00	2.00	3.00																8.00				8.00			0.27	0.03	0.03			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	002	0		29	10	S4607_002_0	1	Generic	2	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								18.00	36.00	54.00					11.00	22.00	33.00					11.00	22.00	33.00																18.00				18.00			0.60	0.37	0.37			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	002	0		29	10	S4607_002_0	1	Preferred Brand	2	000001	1	2	3	1		111	01	111		1				30	60	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 Brand, Specialty Tier												
S4607	002	0		29	10	S4607_002_0	1	Non-Preferred Brand	2	100100	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											63.27	50	50	50				60.85	50	50	50				50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	002	0		29	10	S4607_002_0	1	Specialty Tier	2	010010	1	1	5	1		010	01	010		1				30					30						30		31											547.05	25						539.22	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	003	0		29	10	S4607_003_0	1	Preferred Generic	2	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	24.00					1.00	2.00	3.00					1.00	2.00	3.00																8.00				8.00			0.27	0.03	0.03			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	003	0		29	10	S4607_003_0	1	Generic	2	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								16.00	32.00	48.00					9.00	18.00	27.00					9.00	18.00	27.00																16.00				16.00			0.53	0.30	0.30			0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	003	0		29	10	S4607_003_0	1	Preferred Brand	2	000001	1	2	3	1		111	01	111		1				30	60	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 Brand, Specialty Tier												
S4607	003	0		29	10	S4607_003_0	1	Non-Preferred Brand	2	100100	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											55.48	50	50	50				51.58	50	50	50				50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	003	0		29	10	S4607_003_0	1	Specialty Tier	2	010010	1	1	5	1		010	01	010		1				30					30						30		31											552.53	25						545.13	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	008	0		29	10	S4607_008_0	1	Preferred Generic	2	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	24.00					1.00	2.00	3.00					1.00	2.00	3.00																8.00				8.00			0.27	0.03	0.03			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	008	0		29	10	S4607_008_0	1	Generic	2	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								13.00	26.00	39.00					6.00	12.00	18.00					6.00	12.00	18.00																13.00				13.00			0.43	0.20	0.20			0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	008	0		29	10	S4607_008_0	1	Preferred Brand	2	000001	1	2	3	1		111	01	111		1				30	60	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 Brand, Specialty Tier												
S4607	008	0		29	10	S4607_008_0	1	Non-Preferred Brand	2	100100	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											43.50	50	50	50				41.81	50	50	50				50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	008	0		29	10	S4607_008_0	1	Specialty Tier	2	010010	1	1	5	1		010	01	010		1				30					30						30		31											536.80	25						528.80	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	009	0		29	10	S4607_009_0	1	Preferred Generic	2	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	24.00					1.00	2.00	3.00					1.00	2.00	3.00																8.00				8.00			0.27	0.03	0.03			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	009	0		29	10	S4607_009_0	1	Generic	2	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	36.00					5.00	10.00	15.00					5.00	10.00	15.00																12.00				12.00			0.40	0.17	0.17			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	009	0		29	10	S4607_009_0	1	Preferred Brand	2	000001	1	2	3	1		111	01	111		1				30	60	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 Brand, Specialty Tier												
S4607	009	0		29	10	S4607_009_0	1	Non-Preferred Brand	2	100100	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											49.48	50	50	50				46.62	50	50	50				50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	009	0		29	10	S4607_009_0	1	Specialty Tier	2	010010	1	1	5	1		010	01	010		1				30					30						30		31											475.72	25						470.35	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	010	0		29	10	S4607_010_0	1	Preferred Generic	2	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	24.00					1.00	2.00	3.00					1.00	2.00	3.00																8.00				8.00			0.27	0.03	0.03			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	010	0		29	10	S4607_010_0	1	Generic	2	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	36.00					5.00	10.00	15.00					5.00	10.00	15.00																12.00				12.00			0.40	0.17	0.17			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	010	0		29	10	S4607_010_0	1	Preferred Brand	2	000001	1	2	3	1		111	01	111		1				30	60	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 Brand, Specialty Tier												
S4607	010	0		29	10	S4607_010_0	1	Non-Preferred Brand	2	100100	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											44.38	50	50	50				42.06	50	50	50				50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	010	0		29	10	S4607_010_0	1	Specialty Tier	2	010010	1	1	5	1		010	01	010		1				30					30						30		31											510.74	25						505.48	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	011	0		29	10	S4607_011_0	1	Preferred Generic	2	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	24.00					1.00	2.00	3.00					1.00	2.00	3.00																8.00				8.00			0.27	0.03	0.03			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	011	0		29	10	S4607_011_0	1	Generic	2	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	36.00					5.00	10.00	15.00					5.00	10.00	15.00																12.00				12.00			0.40	0.17	0.17			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	011	0		29	10	S4607_011_0	1	Preferred Brand	2	000001	1	2	3	1		111	01	111		1				30	60	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 Brand, Specialty Tier												
S4607	011	0		29	10	S4607_011_0	1	Non-Preferred Brand	2	100100	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											42.91	50	50	50				40.27	50	50	50				50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	011	0		29	10	S4607_011_0	1	Specialty Tier	2	010010	1	1	5	1		010	01	010		1				30					30						30		31											487.09	25						491.06	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	012	0		29	10	S4607_012_0	1	Preferred Generic	2	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	24.00					1.00	2.00	3.00					1.00	2.00	3.00																8.00				8.00			0.27	0.03	0.03			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	012	0		29	10	S4607_012_0	1	Generic	2	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	36.00					5.00	10.00	15.00					5.00	10.00	15.00																12.00				12.00			0.40	0.17	0.17			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	012	0		29	10	S4607_012_0	1	Preferred Brand	2	000001	1	2	3	1		111	01	111		1				30	60	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 Brand, Specialty Tier												
S4607	012	0		29	10	S4607_012_0	1	Non-Preferred Brand	2	100100	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											42.16	50	50	50				38.25	50	50	50				50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	012	0		29	10	S4607_012_0	1	Specialty Tier	2	010010	1	1	5	1		010	01	010		1				30					30						30		31											487.51	25						490.32	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	013	0		29	10	S4607_013_0	1	Preferred Generic	2	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	24.00					1.00	2.00	3.00					1.00	2.00	3.00																8.00				8.00			0.27	0.03	0.03			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	013	0		29	10	S4607_013_0	1	Generic	2	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								13.00	26.00	39.00					6.00	12.00	18.00					6.00	12.00	18.00																13.00				13.00			0.43	0.20	0.20			0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	013	0		29	10	S4607_013_0	1	Preferred Brand	2	000001	1	2	3	1		111	01	111		1				30	60	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 Brand, Specialty Tier												
S4607	013	0		29	10	S4607_013_0	1	Non-Preferred Brand	2	100100	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											48.10	50	50	50				46.06	50	50	50				50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	013	0		29	10	S4607_013_0	1	Specialty Tier	2	010010	1	1	5	1		010	01	010		1				30					30						30		31											513.51	25						506.47	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	014	0		29	10	S4607_014_0	1	Preferred Generic	2	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	24.00					1.00	2.00	3.00					1.00	2.00	3.00																8.00				8.00			0.27	0.03	0.03			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	014	0		29	10	S4607_014_0	1	Generic	2	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								13.00	26.00	39.00					6.00	12.00	18.00					6.00	12.00	18.00																13.00				13.00			0.43	0.20	0.20			0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	014	0		29	10	S4607_014_0	1	Preferred Brand	2	000001	1	2	3	1		111	01	111		1				30	60	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 Brand, Specialty Tier												
S4607	014	0		29	10	S4607_014_0	1	Non-Preferred Brand	2	100100	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											42.53	50	50	50				39.11	50	50	50				50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	014	0		29	10	S4607_014_0	1	Specialty Tier	2	010010	1	1	5	1		010	01	010		1				30					30						30		31											517.92	25						515.63	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	015	0		29	10	S4607_015_0	1	Preferred Generic	2	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	24.00					1.00	2.00	3.00					1.00	2.00	3.00																8.00				8.00			0.27	0.03	0.03			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	015	0		29	10	S4607_015_0	1	Generic	2	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	36.00					5.00	10.00	15.00					5.00	10.00	15.00																12.00				12.00			0.40	0.17	0.17			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	015	0		29	10	S4607_015_0	1	Preferred Brand	2	000001	1	2	3	1		111	01	111		1				30	60	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 Brand, Specialty Tier												
S4607	015	0		29	10	S4607_015_0	1	Non-Preferred Brand	2	100100	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											43.61	50	50	50				40.03	50	50	50				50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	015	0		29	10	S4607_015_0	1	Specialty Tier	2	010010	1	1	5	1		010	01	010		1				30					30						30		31											521.50	25						525.37	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	016	0		29	10	S4607_016_0	1	Preferred Generic	2	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	24.00					1.00	2.00	3.00					1.00	2.00	3.00																8.00				8.00			0.27	0.03	0.03			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	016	0		29	10	S4607_016_0	1	Generic	2	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	36.00					5.00	10.00	15.00					5.00	10.00	15.00																12.00				12.00			0.40	0.17	0.17			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	016	0		29	10	S4607_016_0	1	Preferred Brand	2	000001	1	2	3	1		111	01	111		1				30	60	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 Brand, Specialty Tier												
S4607	016	0		29	10	S4607_016_0	1	Non-Preferred Brand	2	100100	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											41.99	50	50	50				39.65	50	50	50				50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	016	0		29	10	S4607_016_0	1	Specialty Tier	2	010010	1	1	5	1		010	01	010		1				30					30						30		31											524.87	25						522.18	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	017	0		29	10	S4607_017_0	1	Preferred Generic	2	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	24.00					1.00	2.00	3.00					1.00	2.00	3.00																8.00				8.00			0.27	0.03	0.03			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	017	0		29	10	S4607_017_0	1	Generic	2	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	36.00					5.00	10.00	15.00					5.00	10.00	15.00																12.00				12.00			0.40	0.17	0.17			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	017	0		29	10	S4607_017_0	1	Preferred Brand	2	000001	1	2	3	1		111	01	111		1				30	60	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 Brand, Specialty Tier												
S4607	017	0		29	10	S4607_017_0	1	Non-Preferred Brand	2	100100	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											43.84	50	50	50				38.12	50	50	50				50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	017	0		29	10	S4607_017_0	1	Specialty Tier	2	010010	1	1	5	1		010	01	010		1				30					30						30		31											484.46	25						492.33	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	018	0		29	10	S4607_018_0	1	Preferred Generic	2	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	24.00					1.00	2.00	3.00					1.00	2.00	3.00																8.00				8.00			0.27	0.03	0.03			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	018	0		29	10	S4607_018_0	1	Generic	2	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	36.00					5.00	10.00	15.00					5.00	10.00	15.00																12.00				12.00			0.40	0.17	0.17			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	018	0		29	10	S4607_018_0	1	Preferred Brand	2	000001	1	2	3	1		111	01	111		1				30	60	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 Brand, Specialty Tier												
S4607	018	0		29	10	S4607_018_0	1	Non-Preferred Brand	2	100100	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											42.82	50	50	50				39.76	50	50	50				50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	018	0		29	10	S4607_018_0	1	Specialty Tier	2	010010	1	1	5	1		010	01	010		1				30					30						30		31											505.14	25						503.25	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	019	0		29	10	S4607_019_0	1	Preferred Generic	2	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	24.00					1.00	2.00	3.00					1.00	2.00	3.00																8.00				8.00			0.27	0.03	0.03			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	019	0		29	10	S4607_019_0	1	Generic	2	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					8.00	16.00	24.00					8.00	16.00	24.00																15.00				15.00			0.50	0.27	0.27			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	019	0		29	10	S4607_019_0	1	Preferred Brand	2	000001	1	2	3	1		111	01	111		1				30	60	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 Brand, Specialty Tier												
S4607	019	0		29	10	S4607_019_0	1	Non-Preferred Brand	2	100100	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											52.20	50	50	50				47.88	50	50	50				50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	019	0		29	10	S4607_019_0	1	Specialty Tier	2	010010	1	1	5	1		010	01	010		1				30					30						30		31											585.09	25						584.78	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	020	0		29	10	S4607_020_0	1	Preferred Generic	2	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	24.00					1.00	2.00	3.00					1.00	2.00	3.00																8.00				8.00			0.27	0.03	0.03			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	020	0		29	10	S4607_020_0	1	Generic	2	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	36.00					5.00	10.00	15.00					5.00	10.00	15.00																12.00				12.00			0.40	0.17	0.17			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	020	0		29	10	S4607_020_0	1	Preferred Brand	2	000001	1	2	3	1		111	01	111		1				30	60	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 Brand, Specialty Tier												
S4607	020	0		29	10	S4607_020_0	1	Non-Preferred Brand	2	100100	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											41.90	50	50	50				40.31	50	50	50				50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	020	0		29	10	S4607_020_0	1	Specialty Tier	2	010010	1	1	5	1		010	01	010		1				30					30						30		31											536.62	25						528.23	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	021	0		29	10	S4607_021_0	1	Preferred Generic	2	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	24.00					1.00	2.00	3.00					1.00	2.00	3.00																8.00				8.00			0.27	0.03	0.03			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	021	0		29	10	S4607_021_0	1	Generic	2	010000	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	21.00																14.00				14.00			0.47	0.23	0.23			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	021	0		29	10	S4607_021_0	1	Preferred Brand	2	000001	1	2	3	1		111	01	111		1				30	60	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 Brand, Specialty Tier												
S4607	021	0		29	10	S4607_021_0	1	Non-Preferred Brand	2	100100	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											48.18	50	50	50				43.57	50	50	50				50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	021	0		29	10	S4607_021_0	1	Specialty Tier	2	010010	1	1	5	1		010	01	010		1				30					30						30		31											542.83	25						540.22	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	022	0		29	10	S4607_022_0	1	Preferred Generic	2	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	24.00					1.00	2.00	3.00					1.00	2.00	3.00																8.00				8.00			0.27	0.03	0.03			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	022	0		29	10	S4607_022_0	1	Generic	2	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					8.00	16.00	24.00					8.00	16.00	24.00																15.00				15.00			0.50	0.27	0.27			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	022	0		29	10	S4607_022_0	1	Preferred Brand	2	000001	1	2	3	1		111	01	111		1				30	60	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 Brand, Specialty Tier												
S4607	022	0		29	10	S4607_022_0	1	Non-Preferred Brand	2	100100	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											49.25	50	50	50				46.31	50	50	50				50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	022	0		29	10	S4607_022_0	1	Specialty Tier	2	010010	1	1	5	1		010	01	010		1				30					30						30		31											557.59	25						561.05	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	023	0		29	10	S4607_023_0	1	Preferred Generic	2	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	24.00					1.00	2.00	3.00					1.00	2.00	3.00																8.00				8.00			0.27	0.03	0.03			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	023	0		29	10	S4607_023_0	1	Generic	2	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								16.00	32.00	48.00					9.00	18.00	27.00					9.00	18.00	27.00																16.00				16.00			0.53	0.30	0.30			0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	023	0		29	10	S4607_023_0	1	Preferred Brand	2	000001	1	2	3	1		111	01	111		1				30	60	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 Brand, Specialty Tier												
S4607	023	0		29	10	S4607_023_0	1	Non-Preferred Brand	2	100100	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											54.78	50	50	50				52.06	50	50	50				50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	023	0		29	10	S4607_023_0	1	Specialty Tier	2	010010	1	1	5	1		010	01	010		1				30					30						30		31											520.14	25						514.42	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	024	0		29	10	S4607_024_0	1	Preferred Generic	2	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								8.00	16.00	24.00					1.00	2.00	3.00					1.00	2.00	3.00																8.00				8.00			0.27	0.03	0.03			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	024	0		29	10	S4607_024_0	1	Generic	2	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31								12.00	24.00	36.00					5.00	10.00	15.00					5.00	10.00	15.00																12.00				12.00			0.40	0.17	0.17			0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	024	0		29	10	S4607_024_0	1	Preferred Brand	2	000001	1	2	3	1		111	01	111		1				30	60	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 Brand, Specialty Tier												
S4607	024	0		29	10	S4607_024_0	1	Non-Preferred Brand	2	100100	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											49.12	50	50	50				46.15	50	50	50				50	50	50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4607	024	0		29	10	S4607_024_0	1	Specialty Tier	2	010010	1	1	5	1		010	01	010		1				30					30						30		31											505.96	25						499.66	25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S4802	012	0		29	10	S4802_012_0	6	Preferred Generic	3	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	012	0		29	10	S4802_012_0	6	Generic	3	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		42.50				17.00				17.00		0.57				0.57	0.57	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	012	0		29	10	S4802_012_0	6	Preferred Brand	3	000101	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	44.00		132.00																									44.00		132.00				44.00		110.00				44.00				44.00		1.47				1.47	1.47	1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	012	0		29	10	S4802_012_0	6	Non-Preferred Drug	3	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				84.45	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	012	0		29	10	S4802_012_0	6	Specialty Tier	3	010010	1	1	5	1	010		01		010	1	30											30			30		31				2266.70	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	013	0		29	10	S4802_013_0	4	Preferred Generic	3	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	013	0		29	10	S4802_013_0	4	Generic	3	010001	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		35.00				14.00				14.00		0.47				0.47	0.47	0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	013	0		29	10	S4802_013_0	4	Preferred Brand	3	000101	1	2	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												
S4802	013	0		29	10	S4802_013_0	4	Non-Preferred Drug	3	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				98.98	49		49																								49		49				49		49			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	013	0		29	10	S4802_013_0	4	Specialty Tier	3	010010	1	1	5	1	010		01		010	1	30											30			30		31				2516.46	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	014	0		29	10	S4802_014_0	4	Preferred Generic	3	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	014	0		29	10	S4802_014_0	4	Generic	3	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		37.50				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	014	0		29	10	S4802_014_0	4	Preferred Brand	3	000101	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	37.00		111.00																									37.00		111.00				37.00		92.50				37.00				37.00		1.23				1.23	1.23	1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	014	0		29	10	S4802_014_0	4	Non-Preferred Drug	3	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				80.86	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	014	0		29	10	S4802_014_0	4	Specialty Tier	3	010010	1	1	5	1	010		01		010	1	30											30			30		31				2316.64	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	020	0		29	10	S4802_020_0	4	Preferred Generic	3	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	020	0		29	10	S4802_020_0	4	Generic	3	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	11.00		33.00																									11.00		33.00				11.00		27.50				11.00				11.00		0.37				0.37	0.37	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	020	0		29	10	S4802_020_0	4	Preferred Brand	3	000101	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	40.00		120.00																									40.00		120.00				40.00		100.00				40.00				40.00		1.33				1.33	1.33	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	020	0		29	10	S4802_020_0	4	Non-Preferred Drug	3	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				85.75	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	020	0		29	10	S4802_020_0	4	Specialty Tier	3	010010	1	1	5	1	010		01		010	1	30											30			30		31				2341.37	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	021	0		29	10	S4802_021_0	4	Preferred Generic	3	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	021	0		29	10	S4802_021_0	4	Generic	3	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	11.00		33.00																									11.00		33.00				11.00		27.50				11.00				11.00		0.37				0.37	0.37	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	021	0		29	10	S4802_021_0	4	Preferred Brand	3	000101	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	35.00		105.00																									35.00		105.00				35.00		87.50				35.00				35.00		1.17				1.17	1.17	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	021	0		29	10	S4802_021_0	4	Non-Preferred Drug	3	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				90.61	49		49																								49		49				49		49			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	021	0		29	10	S4802_021_0	4	Specialty Tier	3	010010	1	1	5	1	010		01		010	1	30											30			30		31				2236.30	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	069	0		29	10	S4802_069_0	5	Preferred Generic	3	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	069	0		29	10	S4802_069_0	5	Generic	3	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	11.00		33.00																									11.00		33.00				11.00		27.50				11.00				11.00		0.37				0.37	0.37	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	069	0		29	10	S4802_069_0	5	Preferred Brand	3	000101	1	2	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												
S4802	069	0		29	10	S4802_069_0	5	Non-Preferred Drug	3	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				95.41	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	069	0		29	10	S4802_069_0	5	Specialty Tier	3	010010	1	1	5	1	010		01		010	1	30											30			30		31				2512.87	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	070	0		29	10	S4802_070_0	4	Preferred Generic	3	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	070	0		29	10	S4802_070_0	4	Generic	3	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	19.00		57.00																									19.00		57.00				19.00		47.50				19.00				19.00		0.63				0.63	0.63	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	070	0		29	10	S4802_070_0	4	Preferred Brand	3	000101	1	2	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												
S4802	070	0		29	10	S4802_070_0	4	Non-Preferred Drug	3	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				75.63	46		46																								46		46				46		46			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	070	0		29	10	S4802_070_0	4	Specialty Tier	3	010010	1	1	5	1	010		01		010	1	30											30			30		31				2724.23	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	071	0		29	10	S4802_071_0	4	Preferred Generic	3	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	071	0		29	10	S4802_071_0	4	Generic	3	010001	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		30.00				12.00				12.00		0.40				0.40	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	071	0		29	10	S4802_071_0	4	Preferred Brand	3	000101	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	46.00		138.00																									46.00		138.00				46.00		115.00				46.00				46.00		1.53				1.53	1.53	1.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	071	0		29	10	S4802_071_0	4	Non-Preferred Drug	3	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				84.97	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	071	0		29	10	S4802_071_0	4	Specialty Tier	3	010010	1	1	5	1	010		01		010	1	30											30			30		31				2304.03	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	072	0		29	10	S4802_072_0	4	Preferred Generic	3	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	1.00		3.00																									1.00		3.00				1.00		0.00				1.00				1.00		0.03				0.03	0.03	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	072	0		29	10	S4802_072_0	4	Generic	3	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		42.50				17.00				17.00		0.57				0.57	0.57	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	072	0		29	10	S4802_072_0	4	Preferred Brand	3	000101	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	42.00		126.00																									42.00		126.00				42.00		105.00				42.00				42.00		1.40				1.40	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	072	0		29	10	S4802_072_0	4	Non-Preferred Drug	3	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				77.96	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	072	0		29	10	S4802_072_0	4	Specialty Tier	3	010010	1	1	5	1	010		01		010	1	30											30			30		31				2672.58	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	073	0		29	10	S4802_073_0	5	Preferred Generic	3	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	073	0		29	10	S4802_073_0	5	Generic	3	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		42.50				17.00				17.00		0.57				0.57	0.57	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	073	0		29	10	S4802_073_0	5	Preferred Brand	3	000101	1	2	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												
S4802	073	0		29	10	S4802_073_0	5	Non-Preferred Drug	3	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				75.85	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	073	0		29	10	S4802_073_0	5	Specialty Tier	3	010010	1	1	5	1	010		01		010	1	30											30			30		31				2425.91	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	074	0		29	10	S4802_074_0	4	Preferred Generic	3	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	074	0		29	10	S4802_074_0	4	Generic	3	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		50.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	074	0		29	10	S4802_074_0	4	Preferred Brand	3	000101	1	2	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												
S4802	074	0		29	10	S4802_074_0	4	Non-Preferred Drug	3	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				81.15	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	074	0		29	10	S4802_074_0	4	Specialty Tier	3	010010	1	1	5	1	010		01		010	1	30											30			30		31				2400.81	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	075	0		29	10	S4802_075_0	5	Preferred Generic	3	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	075	0		29	10	S4802_075_0	5	Generic	3	010001	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		25.00				10.00				10.00		0.33				0.33	0.33	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	075	0		29	10	S4802_075_0	5	Preferred Brand	3	000101	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	37.00		111.00																									37.00		111.00				37.00		92.50				37.00				37.00		1.23				1.23	1.23	1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	075	0		29	10	S4802_075_0	5	Non-Preferred Drug	3	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				94.50	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	075	0		29	10	S4802_075_0	5	Specialty Tier	3	010010	1	1	5	1	010		01		010	1	30											30			30		31				2218.53	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	076	0		29	10	S4802_076_0	4	Preferred Generic	3	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	076	0		29	10	S4802_076_0	4	Generic	3	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	16.00		48.00																									16.00		48.00				16.00		40.00				16.00				16.00		0.53				0.53	0.53	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	076	0		29	10	S4802_076_0	4	Preferred Brand	3	000101	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	39.00		117.00																									39.00		117.00				39.00		97.50				39.00				39.00		1.30				1.30	1.30	1.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	076	0		29	10	S4802_076_0	4	Non-Preferred Drug	3	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				90.67	46		46																								46		46				46		46			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	076	0		29	10	S4802_076_0	4	Specialty Tier	3	010010	1	1	5	1	010		01		010	1	30											30			30		31				2280.09	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	077	0		29	10	S4802_077_0	4	Preferred Generic	3	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	077	0		29	10	S4802_077_0	4	Generic	3	010001	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		35.00				14.00				14.00		0.47				0.47	0.47	0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	077	0		29	10	S4802_077_0	4	Preferred Brand	3	000101	1	2	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												
S4802	077	0		29	10	S4802_077_0	4	Non-Preferred Drug	3	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				98.07	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	077	0		29	10	S4802_077_0	4	Specialty Tier	3	010010	1	1	5	1	010		01		010	1	30											30			30		31				2201.37	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	078	0		29	10	S4802_078_0	4	Preferred Generic	3	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	078	0		29	10	S4802_078_0	4	Generic	3	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	15.00		45.00																									15.00		45.00				15.00		37.50				15.00				15.00		0.50				0.50	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	078	0		29	10	S4802_078_0	4	Preferred Brand	3	000101	1	2	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												
S4802	078	0		29	10	S4802_078_0	4	Non-Preferred Drug	3	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				99.47	47		47																								47		47				47		47			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	078	0		29	10	S4802_078_0	4	Specialty Tier	3	010010	1	1	5	1	010		01		010	1	30											30			30		31				2485.47	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	079	0		29	10	S4802_079_0	4	Preferred Generic	3	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	1.00		3.00																									1.00		3.00				1.00		0.00				1.00				1.00		0.03				0.03	0.03	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	079	0		29	10	S4802_079_0	4	Generic	3	010001	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		30.00				12.00				12.00		0.40				0.40	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	079	0		29	10	S4802_079_0	4	Preferred Brand	3	000101	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	46.00		138.00																									46.00		138.00				46.00		115.00				46.00				46.00		1.53				1.53	1.53	1.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	079	0		29	10	S4802_079_0	4	Non-Preferred Drug	3	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				83.92	49		49																								49		49				49		49			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	079	0		29	10	S4802_079_0	4	Specialty Tier	3	010010	1	1	5	1	010		01		010	1	30											30			30		31				2352.98	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	080	0		29	10	S4802_080_0	4	Preferred Generic	3	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	080	0		29	10	S4802_080_0	4	Generic	3	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	16.00		48.00																									16.00		48.00				16.00		40.00				16.00				16.00		0.53				0.53	0.53	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	080	0		29	10	S4802_080_0	4	Preferred Brand	3	000101	1	2	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												
S4802	080	0		29	10	S4802_080_0	4	Non-Preferred Drug	3	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				91.55	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	080	0		29	10	S4802_080_0	4	Specialty Tier	3	010010	1	1	5	1	010		01		010	1	30											30			30		31				2290.26	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	081	0		29	10	S4802_081_0	4	Preferred Generic	3	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	081	0		29	10	S4802_081_0	4	Generic	3	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	11.00		33.00																									11.00		33.00				11.00		27.50				11.00				11.00		0.37				0.37	0.37	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	081	0		29	10	S4802_081_0	4	Preferred Brand	3	000101	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	44.00		132.00																									44.00		132.00				44.00		110.00				44.00				44.00		1.47				1.47	1.47	1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	081	0		29	10	S4802_081_0	4	Non-Preferred Drug	3	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				93.61	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	081	0		29	10	S4802_081_0	4	Specialty Tier	3	010010	1	1	5	1	010		01		010	1	30											30			30		31				2632.00	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	082	0		29	10	S4802_082_0	4	Preferred Generic	3	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	082	0		29	10	S4802_082_0	4	Generic	3	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	18.00		54.00																									18.00		54.00				18.00		45.00				18.00				18.00		0.60				0.60	0.60	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	082	0		29	10	S4802_082_0	4	Preferred Brand	3	000101	1	2	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												
S4802	082	0		29	10	S4802_082_0	4	Non-Preferred Drug	3	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				79.20	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	082	0		29	10	S4802_082_0	4	Specialty Tier	3	010010	1	1	5	1	010		01		010	1	30											30			30		31				2241.80	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	083	0		29	10	S4802_083_0	5	Preferred Generic	3	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	083	0		29	10	S4802_083_0	5	Generic	3	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	13.00		39.00																									13.00		39.00				13.00		32.50				13.00				13.00		0.43				0.43	0.43	0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	083	0		29	10	S4802_083_0	5	Preferred Brand	3	000101	1	2	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												
S4802	083	0		29	10	S4802_083_0	5	Non-Preferred Drug	3	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				81.61	47		47																								47		47				47		47			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	083	0		29	10	S4802_083_0	5	Specialty Tier	3	010010	1	1	5	1	010		01		010	1	30											30			30		31				2643.31	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	084	0		29	10	S4802_084_0	4	Preferred Generic	3	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	084	0		29	10	S4802_084_0	4	Generic	3	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	13.00		39.00																									13.00		39.00				13.00		32.50				13.00				13.00		0.43				0.43	0.43	0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	084	0		29	10	S4802_084_0	4	Preferred Brand	3	000101	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	43.00		129.00																									43.00		129.00				43.00		107.50				43.00				43.00		1.43				1.43	1.43	1.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	084	0		29	10	S4802_084_0	4	Non-Preferred Drug	3	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				92.66	49		49																								49		49				49		49			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	084	0		29	10	S4802_084_0	4	Specialty Tier	3	010010	1	1	5	1	010		01		010	1	30											30			30		31				2252.72	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	085	0		29	10	S4802_085_0	4	Preferred Generic	3	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	085	0		29	10	S4802_085_0	4	Generic	3	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	19.00		57.00																									19.00		57.00				19.00		47.50				19.00				19.00		0.63				0.63	0.63	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	085	0		29	10	S4802_085_0	4	Preferred Brand	3	000101	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	44.00		132.00																									44.00		132.00				44.00		110.00				44.00				44.00		1.47				1.47	1.47	1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	085	0		29	10	S4802_085_0	4	Non-Preferred Drug	3	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				96.25	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	085	0		29	10	S4802_085_0	4	Specialty Tier	3	010010	1	1	5	1	010		01		010	1	30											30			30		31				2225.11	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	086	0		29	10	S4802_086_0	4	Preferred Generic	3	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	086	0		29	10	S4802_086_0	4	Generic	3	010001	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		30.00				12.00				12.00		0.40				0.40	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	086	0		29	10	S4802_086_0	4	Preferred Brand	3	000101	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	44.00		132.00																									44.00		132.00				44.00		110.00				44.00				44.00		1.47				1.47	1.47	1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	086	0		29	10	S4802_086_0	4	Non-Preferred Drug	3	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				92.88	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	086	0		29	10	S4802_086_0	4	Specialty Tier	3	010010	1	1	5	1	010		01		010	1	30											30			30		31				2317.14	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	087	0		29	10	S4802_087_0	4	Preferred Generic	3	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	087	0		29	10	S4802_087_0	4	Generic	3	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	17.00		51.00																									17.00		51.00				17.00		42.50				17.00				17.00		0.57				0.57	0.57	0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	087	0		29	10	S4802_087_0	4	Preferred Brand	3	000101	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		112.50				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	087	0		29	10	S4802_087_0	4	Non-Preferred Drug	3	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				88.80	49		49																								49		49				49		49			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	087	0		29	10	S4802_087_0	4	Specialty Tier	3	010010	1	1	5	1	010		01		010	1	30											30			30		31				2801.35	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	088	0		29	10	S4802_088_0	4	Preferred Generic	3	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	088	0		29	10	S4802_088_0	4	Generic	3	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	18.00		54.00																									18.00		54.00				18.00		45.00				18.00				18.00		0.60				0.60	0.60	0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	088	0		29	10	S4802_088_0	4	Preferred Brand	3	000101	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	39.00		117.00																									39.00		117.00				39.00		97.50				39.00				39.00		1.30				1.30	1.30	1.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	088	0		29	10	S4802_088_0	4	Non-Preferred Drug	3	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				81.81	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	088	0		29	10	S4802_088_0	4	Specialty Tier	3	010010	1	1	5	1	010		01		010	1	30											30			30		31				2904.83	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	089	0		29	10	S4802_089_0	5	Preferred Generic	3	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	089	0		29	10	S4802_089_0	5	Generic	3	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	13.00		39.00																									13.00		39.00				13.00		32.50				13.00				13.00		0.43				0.43	0.43	0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	089	0		29	10	S4802_089_0	5	Preferred Brand	3	000101	1	2	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												
S4802	089	0		29	10	S4802_089_0	5	Non-Preferred Drug	3	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				80.86	44		44																								44		44				44		44			44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	089	0		29	10	S4802_089_0	5	Specialty Tier	3	010010	1	1	5	1	010		01		010	1	30											30			30		31				2527.04	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	090	0		29	10	S4802_090_0	4	Preferred Generic	3	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	090	0		29	10	S4802_090_0	4	Generic	3	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	19.00		57.00																									19.00		57.00				19.00		47.50				19.00				19.00		0.63				0.63	0.63	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	090	0		29	10	S4802_090_0	4	Preferred Brand	3	000101	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	42.00		126.00																									42.00		126.00				42.00		105.00				42.00				42.00		1.40				1.40	1.40	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	090	0		29	10	S4802_090_0	4	Non-Preferred Drug	3	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				77.11	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	090	0		29	10	S4802_090_0	4	Specialty Tier	3	010010	1	1	5	1	010		01		010	1	30											30			30		31				2752.78	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	091	0		29	10	S4802_091_0	4	Preferred Generic	3	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	091	0		29	10	S4802_091_0	4	Generic	3	010001	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		30.00				12.00				12.00		0.40				0.40	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	091	0		29	10	S4802_091_0	4	Preferred Brand	3	000101	1	2	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												
S4802	091	0		29	10	S4802_091_0	4	Non-Preferred Drug	3	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				79.00	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	091	0		29	10	S4802_091_0	4	Specialty Tier	3	010010	1	1	5	1	010		01		010	1	30											30			30		31				2765.96	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	092	0		29	10	S4802_092_0	5	Preferred Generic	3	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	092	0		29	10	S4802_092_0	5	Generic	3	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	16.00		48.00																									16.00		48.00				16.00		40.00				16.00				16.00		0.53				0.53	0.53	0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	092	0		29	10	S4802_092_0	5	Preferred Brand	3	000101	1	2	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												
S4802	092	0		29	10	S4802_092_0	5	Non-Preferred Drug	3	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				76.90	47		47																								47		47				47		47			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	092	0		29	10	S4802_092_0	5	Specialty Tier	3	010010	1	1	5	1	010		01		010	1	30											30			30		31				2674.57	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	093	0		29	10	S4802_093_0	4	Preferred Generic	3	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	093	0		29	10	S4802_093_0	4	Generic	3	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	11.00		33.00																									11.00		33.00				11.00		27.50				11.00				11.00		0.37				0.37	0.37	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	093	0		29	10	S4802_093_0	4	Preferred Brand	3	000101	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	45.00		135.00																									45.00		135.00				45.00		112.50				45.00				45.00		1.50				1.50	1.50	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	093	0		29	10	S4802_093_0	4	Non-Preferred Drug	3	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				81.94	49		49																								49		49				49		49			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	093	0		29	10	S4802_093_0	4	Specialty Tier	3	010010	1	1	5	1	010		01		010	1	30											30			30		31				2685.72	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	094	0		29	10	S4802_094_0	4	Preferred Generic	3	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	094	0		29	10	S4802_094_0	4	Generic	3	010001	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		35.00				14.00				14.00		0.47				0.47	0.47	0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	094	0		29	10	S4802_094_0	4	Preferred Brand	3	000101	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	46.00		138.00																									46.00		138.00				46.00		115.00				46.00				46.00		1.53				1.53	1.53	1.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	094	0		29	10	S4802_094_0	4	Non-Preferred Drug	3	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				93.24	48		48																								48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	094	0		29	10	S4802_094_0	4	Specialty Tier	3	010010	1	1	5	1	010		01		010	1	30											30			30		31				2642.68	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	095	0		29	10	S4802_095_0	4	Preferred Generic	3	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	2.00		6.00																									2.00		6.00				2.00		0.00				2.00				2.00		0.07				0.07	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	095	0		29	10	S4802_095_0	4	Generic	3	010001	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		30.00				12.00				12.00		0.40				0.40	0.40	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	095	0		29	10	S4802_095_0	4	Preferred Brand	3	000101	1	2	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												
S4802	095	0		29	10	S4802_095_0	4	Non-Preferred Drug	3	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				87.20	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	095	0		29	10	S4802_095_0	4	Specialty Tier	3	010010	1	1	5	1	010		01		010	1	30											30			30		31				2572.09	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	096	0		29	10	S4802_096_0	4	Preferred Generic	3	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	2.00		6.00																									2.00		6.00				2.00		0.00				2.00				2.00		0.07				0.07	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	096	0		29	10	S4802_096_0	4	Generic	3	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	20.00		60.00																									20.00		60.00				20.00		50.00				20.00				20.00		0.67				0.67	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	096	0		29	10	S4802_096_0	4	Preferred Brand	3	000101	1	2	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												
S4802	096	0		29	10	S4802_096_0	4	Non-Preferred Drug	3	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				94.91	41		41																								41		41				41		41			41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	096	0		29	10	S4802_096_0	4	Specialty Tier	3	010010	1	1	5	1	010		01		010	1	30											30			30		31				2028.88	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	097	0		29	10	S4802_097_0	4	Preferred Generic	3	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	097	0		29	10	S4802_097_0	4	Generic	3	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	11.00		33.00																									11.00		33.00				11.00		27.50				11.00				11.00		0.37				0.37	0.37	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	097	0		29	10	S4802_097_0	4	Preferred Brand	3	000101	1	2	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												
S4802	097	0		29	10	S4802_097_0	4	Non-Preferred Drug	3	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				90.38	50		50																								50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	097	0		29	10	S4802_097_0	4	Specialty Tier	3	010010	1	1	5	1	010		01		010	1	30											30			30		31				2330.30	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	098	0		29	10	S4802_098_0	4	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	098	0		29	10	S4802_098_0	4	Generic	4	010001	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												
S4802	098	0		29	10	S4802_098_0	4	Preferred Brand	4	000101	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		62.50				25.00				25.00		0.83				0.83	0.83	0.81	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	098	0		29	10	S4802_098_0	4	Non-Preferred Drug	4	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				45.64	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	098	0		29	10	S4802_098_0	4	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				3866.73	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	099	0		29	10	S4802_099_0	4	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	099	0		29	10	S4802_099_0	4	Generic	4	010001	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												
S4802	099	0		29	10	S4802_099_0	4	Preferred Brand	4	000101	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	28.00		84.00																									28.00		84.00				28.00		70.00				28.00				28.00		0.93				0.93	0.93	0.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	099	0		29	10	S4802_099_0	4	Non-Preferred Drug	4	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				58.16	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	099	0		29	10	S4802_099_0	4	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				2663.14	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	100	0		29	10	S4802_100_0	4	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	100	0		29	10	S4802_100_0	4	Generic	4	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	2.00		6.00																									2.00		6.00				2.00		5.00				2.00				2.00		0.07				0.07	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	100	0		29	10	S4802_100_0	4	Preferred Brand	4	000101	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	29.00		87.00																									29.00		87.00				29.00		72.50				29.00				29.00		0.97				0.97	0.97	0.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	100	0		29	10	S4802_100_0	4	Non-Preferred Drug	4	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				60.97	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	100	0		29	10	S4802_100_0	4	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				2695.95	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	101	0		29	10	S4802_101_0	4	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	101	0		29	10	S4802_101_0	4	Generic	4	010001	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		22.50				9.00				9.00		0.30				0.30	0.30	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	101	0		29	10	S4802_101_0	4	Preferred Brand	4	000101	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	30.00		90.00																									30.00		90.00				30.00		75.00				30.00				30.00		1.00				1.00	1.00	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	101	0		29	10	S4802_101_0	4	Non-Preferred Drug	4	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				57.84	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	101	0		29	10	S4802_101_0	4	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				3754.05	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	102	0		29	10	S4802_102_0	4	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	102	0		29	10	S4802_102_0	4	Generic	4	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	4.00		12.00																									4.00		12.00				4.00		10.00				4.00				4.00		0.13				0.13	0.13	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	102	0		29	10	S4802_102_0	4	Preferred Brand	4	000101	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	29.00		87.00																									29.00		87.00				29.00		72.50				29.00				29.00		0.97				0.97	0.97	0.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	102	0		29	10	S4802_102_0	4	Non-Preferred Drug	4	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				53.39	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	102	0		29	10	S4802_102_0	4	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				2459.92	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	103	0		29	10	S4802_103_0	4	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	103	0		29	10	S4802_103_0	4	Generic	4	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	3.00		9.00																									3.00		9.00				3.00		7.50				3.00				3.00		0.10				0.10	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	103	0		29	10	S4802_103_0	4	Preferred Brand	4	000101	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	30.00		90.00																									30.00		90.00				30.00		75.00				30.00				30.00		1.00				1.00	1.00	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	103	0		29	10	S4802_103_0	4	Non-Preferred Drug	4	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				54.48	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	103	0		29	10	S4802_103_0	4	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				2794.06	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	104	0		29	10	S4802_104_0	4	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	104	0		29	10	S4802_104_0	4	Generic	4	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	8.00		24.00																									8.00		24.00				8.00		20.00				8.00				8.00		0.27				0.27	0.27	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	104	0		29	10	S4802_104_0	4	Preferred Brand	4	000101	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	30.00		90.00																									30.00		90.00				30.00		75.00				30.00				30.00		1.00				1.00	1.00	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	104	0		29	10	S4802_104_0	4	Non-Preferred Drug	4	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				49.95	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	104	0		29	10	S4802_104_0	4	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				3380.40	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	105	0		29	10	S4802_105_0	4	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	105	0		29	10	S4802_105_0	4	Generic	4	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	7.00		21.00																									7.00		21.00				7.00		17.50				7.00				7.00		0.23				0.23	0.23	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	105	0		29	10	S4802_105_0	4	Preferred Brand	4	000101	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	30.00		90.00																									30.00		90.00				30.00		75.00				30.00				30.00		1.00				1.00	1.00	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	105	0		29	10	S4802_105_0	4	Non-Preferred Drug	4	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				48.48	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	105	0		29	10	S4802_105_0	4	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				3337.60	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	106	0		29	10	S4802_106_0	4	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	106	0		29	10	S4802_106_0	4	Generic	4	010001	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		22.50				9.00				9.00		0.30				0.30	0.30	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	106	0		29	10	S4802_106_0	4	Preferred Brand	4	000101	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	28.00		84.00																									28.00		84.00				28.00		70.00				28.00				28.00		0.93				0.93	0.93	0.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	106	0		29	10	S4802_106_0	4	Non-Preferred Drug	4	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				49.15	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	106	0		29	10	S4802_106_0	4	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				2795.05	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	107	0		29	10	S4802_107_0	4	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	107	0		29	10	S4802_107_0	4	Generic	4	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	3.00		9.00																									3.00		9.00				3.00		7.50				3.00				3.00		0.10				0.10	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	107	0		29	10	S4802_107_0	4	Preferred Brand	4	000101	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	30.00		90.00																									30.00		90.00				30.00		75.00				30.00				30.00		1.00				1.00	1.00	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	107	0		29	10	S4802_107_0	4	Non-Preferred Drug	4	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				46.02	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	107	0		29	10	S4802_107_0	4	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				2656.10	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	108	0		29	10	S4802_108_0	4	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	108	0		29	10	S4802_108_0	4	Generic	4	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		15.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	108	0		29	10	S4802_108_0	4	Preferred Brand	4	000101	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	32.00		96.00																									32.00		96.00				32.00		80.00				32.00				32.00		1.07				1.07	1.07	1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	108	0		29	10	S4802_108_0	4	Non-Preferred Drug	4	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				54.97	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	108	0		29	10	S4802_108_0	4	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				2311.55	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	109	0		29	10	S4802_109_0	4	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	109	0		29	10	S4802_109_0	4	Generic	4	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	1.00		3.00																									1.00		3.00				1.00		2.50				1.00				1.00		0.03				0.03	0.03	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	109	0		29	10	S4802_109_0	4	Preferred Brand	4	000101	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	30.00		90.00																									30.00		90.00				30.00		75.00				30.00				30.00		1.00				1.00	1.00	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	109	0		29	10	S4802_109_0	4	Non-Preferred Drug	4	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				45.15	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	109	0		29	10	S4802_109_0	4	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				2913.12	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	110	0		29	10	S4802_110_0	4	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	110	0		29	10	S4802_110_0	4	Generic	4	010001	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												
S4802	110	0		29	10	S4802_110_0	4	Preferred Brand	4	000101	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	31.00		93.00																									31.00		93.00				31.00		77.50				31.00				31.00		1.03				1.03	1.03	1.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	110	0		29	10	S4802_110_0	4	Non-Preferred Drug	4	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				49.15	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	110	0		29	10	S4802_110_0	4	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				3638.79	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	111	0		29	10	S4802_111_0	4	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	111	0		29	10	S4802_111_0	4	Generic	4	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	2.00		6.00																									2.00		6.00				2.00		5.00				2.00				2.00		0.07				0.07	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	111	0		29	10	S4802_111_0	4	Preferred Brand	4	000101	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	30.00		90.00																									30.00		90.00				30.00		75.00				30.00				30.00		1.00				1.00	1.00	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	111	0		29	10	S4802_111_0	4	Non-Preferred Drug	4	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				48.92	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	111	0		29	10	S4802_111_0	4	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				3271.48	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	112	0		29	10	S4802_112_0	5	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	112	0		29	10	S4802_112_0	5	Generic	4	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	1.00		3.00																									1.00		3.00				1.00		2.50				1.00				1.00		0.03				0.03	0.03	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	112	0		29	10	S4802_112_0	5	Preferred Brand	4	000101	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	29.00		87.00																									29.00		87.00				29.00		72.50				29.00				29.00		0.97				0.97	0.97	0.94	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	112	0		29	10	S4802_112_0	5	Non-Preferred Drug	4	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				48.99	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	112	0		29	10	S4802_112_0	5	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				2577.65	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	113	0		29	10	S4802_113_0	4	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	113	0		29	10	S4802_113_0	4	Generic	4	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	8.00		24.00																									8.00		24.00				8.00		20.00				8.00				8.00		0.27				0.27	0.27	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	113	0		29	10	S4802_113_0	4	Preferred Brand	4	000101	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	34.00		102.00																									34.00		102.00				34.00		85.00				34.00				34.00		1.13				1.13	1.13	1.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	113	0		29	10	S4802_113_0	4	Non-Preferred Drug	4	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				52.30	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	113	0		29	10	S4802_113_0	4	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				2811.45	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	114	0		29	10	S4802_114_0	4	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	114	0		29	10	S4802_114_0	4	Generic	4	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	4.00		12.00																									4.00		12.00				4.00		10.00				4.00				4.00		0.13				0.13	0.13	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	114	0		29	10	S4802_114_0	4	Preferred Brand	4	000101	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	31.00		93.00																									31.00		93.00				31.00		77.50				31.00				31.00		1.03				1.03	1.03	1.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	114	0		29	10	S4802_114_0	4	Non-Preferred Drug	4	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				49.47	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	114	0		29	10	S4802_114_0	4	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				3191.73	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	115	0		29	10	S4802_115_0	4	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	115	0		29	10	S4802_115_0	4	Generic	4	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	3.00		9.00																									3.00		9.00				3.00		7.50				3.00				3.00		0.10				0.10	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	115	0		29	10	S4802_115_0	4	Preferred Brand	4	000101	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	30.00		90.00																									30.00		90.00				30.00		75.00				30.00				30.00		1.00				1.00	1.00	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	115	0		29	10	S4802_115_0	4	Non-Preferred Drug	4	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				41.55	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	115	0		29	10	S4802_115_0	4	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				2963.98	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	116	0		29	10	S4802_116_0	4	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	116	0		29	10	S4802_116_0	4	Generic	4	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	4.00		12.00																									4.00		12.00				4.00		10.00				4.00				4.00		0.13				0.13	0.13	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	116	0		29	10	S4802_116_0	4	Preferred Brand	4	000101	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	30.00		90.00																									30.00		90.00				30.00		75.00				30.00				30.00		1.00				1.00	1.00	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	116	0		29	10	S4802_116_0	4	Non-Preferred Drug	4	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				43.42	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	116	0		29	10	S4802_116_0	4	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				3028.56	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	117	0		29	10	S4802_117_0	4	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	117	0		29	10	S4802_117_0	4	Generic	4	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	2.00		6.00																									2.00		6.00				2.00		5.00				2.00				2.00		0.07				0.07	0.07	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	117	0		29	10	S4802_117_0	4	Preferred Brand	4	000101	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	31.00		93.00																									31.00		93.00				31.00		77.50				31.00				31.00		1.03				1.03	1.03	1.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	117	0		29	10	S4802_117_0	4	Non-Preferred Drug	4	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				45.72	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	117	0		29	10	S4802_117_0	4	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				2669.39	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	118	0		29	10	S4802_118_0	4	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	118	0		29	10	S4802_118_0	4	Generic	4	010001	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		22.50				9.00				9.00		0.30				0.30	0.30	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	118	0		29	10	S4802_118_0	4	Preferred Brand	4	000101	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	30.00		90.00																									30.00		90.00				30.00		75.00				30.00				30.00		1.00				1.00	1.00	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	118	0		29	10	S4802_118_0	4	Non-Preferred Drug	4	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				50.58	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	118	0		29	10	S4802_118_0	4	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				2941.16	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	119	0		29	10	S4802_119_0	5	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	119	0		29	10	S4802_119_0	5	Generic	4	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	1.00		3.00																									1.00		3.00				1.00		2.50				1.00				1.00		0.03				0.03	0.03	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	119	0		29	10	S4802_119_0	5	Preferred Brand	4	000101	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	27.00		81.00																									27.00		81.00				27.00		67.50				27.00				27.00		0.90				0.90	0.90	0.87	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	119	0		29	10	S4802_119_0	5	Non-Preferred Drug	4	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				44.88	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	119	0		29	10	S4802_119_0	5	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				3410.75	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	120	0		29	10	S4802_120_0	4	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	120	0		29	10	S4802_120_0	4	Generic	4	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		12.50				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	120	0		29	10	S4802_120_0	4	Preferred Brand	4	000101	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	31.00		93.00																									31.00		93.00				31.00		77.50				31.00				31.00		1.03				1.03	1.03	1.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	120	0		29	10	S4802_120_0	4	Non-Preferred Drug	4	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				51.11	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	120	0		29	10	S4802_120_0	4	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				3161.98	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	121	0		29	10	S4802_121_0	4	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	121	0		29	10	S4802_121_0	4	Generic	4	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		15.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	121	0		29	10	S4802_121_0	4	Preferred Brand	4	000101	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	32.00		96.00																									32.00		96.00				32.00		80.00				32.00				32.00		1.07				1.07	1.07	1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	121	0		29	10	S4802_121_0	4	Non-Preferred Drug	4	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				53.10	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	121	0		29	10	S4802_121_0	4	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				2904.12	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	122	0		29	10	S4802_122_0	4	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	122	0		29	10	S4802_122_0	4	Generic	4	010001	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		22.50				9.00				9.00		0.30				0.30	0.30	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	122	0		29	10	S4802_122_0	4	Preferred Brand	4	000101	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	31.00		93.00																									31.00		93.00				31.00		77.50				31.00				31.00		1.03				1.03	1.03	1.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	122	0		29	10	S4802_122_0	4	Non-Preferred Drug	4	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				48.07	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	122	0		29	10	S4802_122_0	4	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				2910.44	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	123	0		29	10	S4802_123_0	4	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	123	0		29	10	S4802_123_0	4	Generic	4	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		15.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	123	0		29	10	S4802_123_0	4	Preferred Brand	4	000101	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	31.00		93.00																									31.00		93.00				31.00		77.50				31.00				31.00		1.03				1.03	1.03	1.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	123	0		29	10	S4802_123_0	4	Non-Preferred Drug	4	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				48.46	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	123	0		29	10	S4802_123_0	4	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				3305.58	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	124	0		29	10	S4802_124_0	4	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	124	0		29	10	S4802_124_0	4	Generic	4	010001	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		22.50				9.00				9.00		0.30				0.30	0.30	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	124	0		29	10	S4802_124_0	4	Preferred Brand	4	000101	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	31.00		93.00																									31.00		93.00				31.00		77.50				31.00				31.00		1.03				1.03	1.03	1.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	124	0		29	10	S4802_124_0	4	Non-Preferred Drug	4	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				47.18	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	124	0		29	10	S4802_124_0	4	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				3875.37	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	125	0		29	10	S4802_125_0	4	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	125	0		29	10	S4802_125_0	4	Generic	4	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		12.50				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	125	0		29	10	S4802_125_0	4	Preferred Brand	4	000101	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	31.00		93.00																									31.00		93.00				31.00		77.50				31.00				31.00		1.03				1.03	1.03	1.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	125	0		29	10	S4802_125_0	4	Non-Preferred Drug	4	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				45.81	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	125	0		29	10	S4802_125_0	4	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				2687.68	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	126	0		29	10	S4802_126_0	4	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	126	0		29	10	S4802_126_0	4	Generic	4	010001	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												
S4802	126	0		29	10	S4802_126_0	4	Preferred Brand	4	000101	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	28.00		84.00																									28.00		84.00				28.00		70.00				28.00				28.00		0.93				0.93	0.93	0.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	126	0		29	10	S4802_126_0	4	Non-Preferred Drug	4	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				48.98	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	126	0		29	10	S4802_126_0	4	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				3264.26	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	127	0		29	10	S4802_127_0	4	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	127	0		29	10	S4802_127_0	4	Generic	4	010001	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												
S4802	127	0		29	10	S4802_127_0	4	Preferred Brand	4	000101	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	24.00		72.00																									24.00		72.00				24.00		60.00				24.00				24.00		0.80				0.80	0.80	0.77	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	127	0		29	10	S4802_127_0	4	Non-Preferred Drug	4	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				45.40	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	127	0		29	10	S4802_127_0	4	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				2610.87	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	128	0		29	10	S4802_128_0	4	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	128	0		29	10	S4802_128_0	4	Generic	4	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	8.00		24.00																									8.00		24.00				8.00		20.00				8.00				8.00		0.27				0.27	0.27	0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	128	0		29	10	S4802_128_0	4	Preferred Brand	4	000101	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	31.00		93.00																									31.00		93.00				31.00		77.50				31.00				31.00		1.03				1.03	1.03	1.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	128	0		29	10	S4802_128_0	4	Non-Preferred Drug	4	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				54.21	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	128	0		29	10	S4802_128_0	4	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				3093.45	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	129	0		29	10	S4802_129_0	4	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	129	0		29	10	S4802_129_0	4	Generic	4	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	6.00		18.00																									6.00		18.00				6.00		15.00				6.00				6.00		0.20				0.20	0.20	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	129	0		29	10	S4802_129_0	4	Preferred Brand	4	000101	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	31.00		93.00																									31.00		93.00				31.00		77.50				31.00				31.00		1.03				1.03	1.03	1.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	129	0		29	10	S4802_129_0	4	Non-Preferred Drug	4	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				49.61	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	129	0		29	10	S4802_129_0	4	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				3344.43	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	130	0		29	10	S4802_130_0	4	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	130	0		29	10	S4802_130_0	4	Generic	4	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	5.00		15.00																									5.00		15.00				5.00		12.50				5.00				5.00		0.17				0.17	0.17	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	130	0		29	10	S4802_130_0	4	Preferred Brand	4	000101	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	31.00		93.00																									31.00		93.00				31.00		77.50				31.00				31.00		1.03				1.03	1.03	1.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	130	0		29	10	S4802_130_0	4	Non-Preferred Drug	4	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				59.11	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	130	0		29	10	S4802_130_0	4	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				2452.00	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	131	0		29	10	S4802_131_0	4	Preferred Generic	4	001001	1	2	1	1	110		01		110	1	30		90				1	2				30		90	30		31	0.00		0.00																									0.00		0.00				0.00		0.00				0.00				0.00		0.00				0.00	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	131	0		29	10	S4802_131_0	4	Generic	4	010001	1	2	2	1	110		01		110	1	30		90				1	2				30		90	30		31	1.00		3.00																									1.00		3.00				1.00		2.50				1.00				1.00		0.03				0.03	0.03	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	131	0		29	10	S4802_131_0	4	Preferred Brand	4	000101	1	2	3	1	110		01		110	1	30		90				1	2				30		90	30		31	30.00		90.00																									30.00		90.00				30.00		75.00				30.00				30.00		1.00				1.00	1.00	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	131	0		29	10	S4802_131_0	4	Non-Preferred Drug	4	100100	1	1	4	1	110		01		110	1	30		90				1	2				30		90	30		31				56.09	45		45																								45		45				45		45			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S4802	131	0		29	10	S4802_131_0	4	Specialty Tier	4	010010	1	1	5	1	010		01		010	1	30											30			30		31				3086.86	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5540	002	0		29	10	S5540_002_0	3	Preferred Generic	3	001000	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	45.00					4.00	8.00	12.00											15.00	30.00	45.00				4.00	8.00	12.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5540	002	0		29	10	S5540_002_0	3	Generic	3	010000	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 Brand, Specialty Tier												
S5540	002	0		29	10	S5540_002_0	3	Preferred Brand	3	010001	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	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 Brand, Specialty Tier												
S5540	002	0		29	10	S5540_002_0	3	Non-Preferred Brand	3	110000	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											99.72	50	50	50				99.72	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5540	002	0		29	10	S5540_002_0	3	Specialty Tier	3	010010	1	1	5	1		010	01		010	1				30								30			30		31											429.43	25						429.43	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5540	004	0		29	10	S5540_004_0	3	Preferred Generic	4	001000	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 Brand, Specialty Tier												
S5540	004	0		29	10	S5540_004_0	3	Preferred Generic	4	001000	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 Brand, Specialty Tier										1		
S5540	004	0		29	10	S5540_004_0	3	Generic	4	010000	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 Brand, Specialty Tier												
S5540	004	0		29	10	S5540_004_0	3	Preferred Brand	4	010001	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 Brand, Specialty Tier												
S5540	004	0		29	10	S5540_004_0	3	Non-Preferred Brand	4	110000	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											57.07	50	50	50				57.07	50	50	50										50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5540	004	0		29	10	S5540_004_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31											587.51	33						587.51	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5552	003	0		29	10	S5552_003_0	2	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5552	003	0		29	10	S5552_003_0	2	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5552	003	0		29	10	S5552_003_0	2	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5552	003	0		29	10	S5552_003_0	2	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5552	003	0		29	10	S5552_003_0	2	Non-Preferred Drug	4	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											93.00	50		50				76.00	44		44										50		50				44		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5552	003	0		29	10	S5552_003_0	2	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.17	3.13		3.17	3.13	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5552	003	0		29	10	S5552_003_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5552	004	0		29	10	S5552_004_0	2	Preferred Generic	2	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0		0.07	0	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5552	004	0		29	10	S5552_004_0	2	Generic	2	010001	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	2	Preferred Brand	2	010001	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											28.00	22		22				25.00	20		20										22		22				20		15			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5552	004	0		29	10	S5552_004_0	2	Non-Preferred Drug	2	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											69.00	35		35				67.00	35		35										35		35				35		30			35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5552	004	0		29	10	S5552_004_0	2	Specialty Tier	2	010010	1	1	5	1		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	2	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5552	005	0		29	10	S5552_005_0	2	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								15.00		45.00					4.00		12.00											15.00		45.00				4.00		8.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5552	005	0		29	10	S5552_005_0	2	Preferred Brand	4	010001	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											32.00	25		25				24.00	20		20										25		25				20		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5552	005	0		29	10	S5552_005_0	2	Non-Preferred Drug	4	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											76.00	44		44				52.00	35		35										44		44				35		30			44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5552	005	0		29	10	S5552_005_0	2	Specialty Tier	4	010010	1	1	5	1		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	001000	1	2	1	1		110	01	110		1				31		90	1	2	31		90				31		31								4.00		12.00					4.00		10.00					4.00		10.00																4.00				4.00			0.13	0.13	0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5584	001	0		29	10	S5584_001_0	3	Generic	3	010000	1	2	2	1		110	01	110		1				31		90	1	2	31		90				31		31								18.00		54.00					18.00		45.00					18.00		45.00																18.00				18.00			0.58	0.58	0.58			0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5584	001	0		29	10	S5584_001_0	3	Preferred Brand	3	000001	1	2	3	1		110	01	110		1				31		90	1	2	31		90				31		31								45.00		135.00					45.00		112.50					45.00		112.50																45.00				45.00			1.45	1.45	1.45			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5584	001	0		29	10	S5584_001_0	3	Non-Preferred Drug	3	100100	1	1	4	1		110	01	110		1				31		90	1	2	31		90				31		31											65.00	45		45				65.00	45		42				45		42															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5584	001	0		29	10	S5584_001_0	3	Specialty Tier	3	010010	1	1	5	1		010	01	010		1				31					31						31		31											1.00	25						1.00	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	001000	1	2	1	1		110	01	110		1				31		90	1	2	31		90				31		31								3.00		9.00					3.00		7.50					3.00		7.50																3.00				3.00			0.10	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5584	002	0		29	10	S5584_002_0	3	Generic	4	010000	1	2	2	1		110	01	110		1				31		90	1	2	31		90				31		31								7.00		21.00					7.00		17.50					7.00		17.50																7.00				7.00			0.23	0.23	0.23			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5584	002	0		29	10	S5584_002_0	3	Preferred Brand	4	000001	1	2	3	1		110	01	110		1				31		90	1	2	31		90				31		31								45.00		135.00					45.00		112.50					45.00		112.50																45.00				45.00			1.45	1.45	1.45			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	100100	1	1	4	1		110	01	110		1				31		90	1	2	31		90				31		31											59.00	45		45				59.00	45		42				45		42															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5584	002	0		29	10	S5584_002_0	3	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				31					31						31		31											1.00	33						1.00	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5593	002	0		29	10	S5593_002_0	4	Preferred Generic	2	001000	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													12.50						0.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5593	002	0		29	10	S5593_002_0	4	Generic	2	010000	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								7.00		21.00					2.00		6.00													17.50						5.00				7.00				7.00			0.23	0.06				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5593	002	0		29	10	S5593_002_0	4	Preferred Brand	2	010001	1	1	3	1		110	01		100	1				31		90	1	2						90	31		31											48.05	25		25				48.05	15		15												25						15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5593	002	0		29	10	S5593_002_0	4	Non-Preferred Drug	2	110000	1	1	4	1		110	01		100	1				31		90	1	2						90	31		31											88.08	50		50				88.08	40		40												50						40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5593	002	0		29	10	S5593_002_0	4	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				31								31			31		31											651.37	25						651.37	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5593	003	0		29	10	S5593_003_0	5	Preferred Generic	4	001000	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													12.50						0.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5593	003	0		29	10	S5593_003_0	5	Preferred Generic	4	001000	1	1	1	3		110	01		100	1				31		90	1	2						90	31		31											3.46	31		31				3.46	26		26												31						26			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5593	003	0		29	10	S5593_003_0	5	Generic	4	010000	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					5.00		15.00													25.00						12.50				10.00				10.00			0.32	0.16				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5593	003	0		29	10	S5593_003_0	5	Generic	4	010000	1	1	2	3		110	01		100	1				31		90	1	2						90	31		31											14.48	31		31				14.48	26		26												31						26			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5593	003	0		29	10	S5593_003_0	5	Preferred Brand	4	010001	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								45.00		135.00					40.00		120.00													112.50						100.00				45.00				45.00			1.45	1.29				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5593	003	0		29	10	S5593_003_0	5	Non-Preferred Drug	4	110000	1	1	4	1		110	01		100	1				31		90	1	2						90	31		31											99.46	50		50				99.46	35		35												50						35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5593	003	0		29	10	S5593_003_0	5	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				31								31			31		31											955.70	33						955.70	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5596	001	0		29	10	S5596_001_0	1	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					1.00	2.00	3.00					1.00	3.00	3.00																9.00				9.00			0.30	0.03	0.03			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	001	0		29	10	S5596_001_0	1	Preferred Generic	4	001000	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					1.00	2.00	3.00					1.00	3.00	3.00																9.00				9.00			0.30	0.03	0.03			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5596	001	0		29	10	S5596_001_0	1	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	001	0		29	10	S5596_001_0	1	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	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, Select Care Drugs												
S5596	001	0		29	10	S5596_001_0	1	Non-Preferred Drug	4	100100	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34											91.61	47	47	47				76.02	39	39	39				39	39	39															47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	001	0		29	10	S5596_001_0	1	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	001	0		29	10	S5596_001_0	1	Select Care Drugs	4	001000	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	001	0		29	10	S5596_001_0	1	Select Care Drugs	4	001000	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5596	003	0		29	10	S5596_003_0	1	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	003	0		29	10	S5596_003_0	1	Preferred Generic	4	001000	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5596	003	0		29	10	S5596_003_0	1	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	003	0		29	10	S5596_003_0	1	Generic	4	010000	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5596	003	0		29	10	S5596_003_0	1	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								45.00	90.00	135.00					25.00	50.00	75.00					25.00	75.00	75.00																45.00				45.00			1.50	0.83	0.83			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	003	0		29	10	S5596_003_0	1	Preferred Brand	4	000101	1	1	3	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34											110.25	60	60	60				108.41	59	59	59				60	60	60															60			60								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	1	
S5596	003	0		29	10	S5596_003_0	1	Non-Preferred Drug	4	100100	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34											86.26	40	40	40				75.48	35	35	35				35	35	35															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	003	0		29	10	S5596_003_0	1	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	003	0		29	10	S5596_003_0	1	Select Care Drugs	4	001000	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	003	0		29	10	S5596_003_0	1	Select Care Drugs	4	001000	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5596	005	0		29	10	S5596_005_0	2	Preferred Generic	3	001000	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	3.00	3.00																19.00				19.00			0.63	0.03	0.03			0.56	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	005	0		29	10	S5596_005_0	2	Generic	3	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								20.00	40.00	60.00					6.00	12.00	18.00					6.00	18.00	18.00																20.00				20.00			0.67	0.20	0.20			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	005	0		29	10	S5596_005_0	2	Preferred Brand	3	000101	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					38.00	76.00	114.00					38.00	114.00	114.00																47.00				47.00			1.57	1.27	1.27			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	005	0		29	10	S5596_005_0	2	Non-Preferred Drug	3	100100	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34											59.51	50	50	50				47.61	40	40	40				40	40	40															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	005	0		29	10	S5596_005_0	2	Specialty Tier	3	010010	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	005	0		29	10	S5596_005_0	2	Select Care Drugs	3	001000	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	006	0		29	10	S5596_006_0	2	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					1.00	2.00	3.00					1.00	3.00	3.00																9.00				9.00			0.30	0.03	0.03			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	006	0		29	10	S5596_006_0	2	Preferred Generic	4	001000	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					1.00	2.00	3.00					1.00	3.00	3.00																9.00				9.00			0.30	0.03	0.03			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5596	006	0		29	10	S5596_006_0	2	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	006	0		29	10	S5596_006_0	2	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	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, Select Care Drugs												
S5596	006	0		29	10	S5596_006_0	2	Non-Preferred Drug	4	100100	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34											87.06	47	47	47				72.24	39	39	39				39	39	39															47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	006	0		29	10	S5596_006_0	2	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	006	0		29	10	S5596_006_0	2	Select Care Drugs	4	001000	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	006	0		29	10	S5596_006_0	2	Select Care Drugs	4	001000	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5596	007	0		29	10	S5596_007_0	2	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	007	0		29	10	S5596_007_0	2	Preferred Generic	4	001000	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5596	007	0		29	10	S5596_007_0	2	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	007	0		29	10	S5596_007_0	2	Generic	4	010000	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5596	007	0		29	10	S5596_007_0	2	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								45.00	90.00	135.00					25.00	50.00	75.00					25.00	75.00	75.00																45.00				45.00			1.50	0.83	0.83			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	007	0		29	10	S5596_007_0	2	Preferred Brand	4	000101	1	1	3	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34											108.37	60	60	60				106.56	59	59	59				60	60	60															60			60								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	1	
S5596	007	0		29	10	S5596_007_0	2	Non-Preferred Drug	4	100100	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34											84.22	40	40	40				73.70	35	35	35				35	35	35															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	007	0		29	10	S5596_007_0	2	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	007	0		29	10	S5596_007_0	2	Select Care Drugs	4	001000	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	007	0		29	10	S5596_007_0	2	Select Care Drugs	4	001000	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5596	009	0		29	10	S5596_009_0	1	Preferred Generic	3	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					1.00	2.00	3.00					1.00	3.00	3.00																9.00				9.00			0.30	0.03	0.03			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	009	0		29	10	S5596_009_0	1	Generic	3	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								15.00	30.00	45.00					5.00	10.00	15.00					5.00	15.00	15.00																15.00				15.00			0.50	0.17	0.17			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	009	0		29	10	S5596_009_0	1	Preferred Brand	3	000101	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					35.00	70.00	105.00					35.00	105.00	105.00																47.00				47.00			1.57	1.17	1.17			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	009	0		29	10	S5596_009_0	1	Non-Preferred Drug	3	100100	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34											66.06	50	50	50				52.85	40	40	40				40	40	40															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	009	0		29	10	S5596_009_0	1	Specialty Tier	3	010010	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	009	0		29	10	S5596_009_0	1	Select Care Drugs	3	001000	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	010	0		29	10	S5596_010_0	1	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					1.00	2.00	3.00					1.00	3.00	3.00																9.00				9.00			0.30	0.03	0.03			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	010	0		29	10	S5596_010_0	1	Preferred Generic	4	001000	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					1.00	2.00	3.00					1.00	3.00	3.00																9.00				9.00			0.30	0.03	0.03			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5596	010	0		29	10	S5596_010_0	1	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	010	0		29	10	S5596_010_0	1	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	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, Select Care Drugs												
S5596	010	0		29	10	S5596_010_0	1	Non-Preferred Drug	4	100100	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34											98.57	47	47	47				81.79	39	39	39				39	39	39															47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	010	0		29	10	S5596_010_0	1	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	010	0		29	10	S5596_010_0	1	Select Care Drugs	4	001000	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	010	0		29	10	S5596_010_0	1	Select Care Drugs	4	001000	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5596	011	0		29	10	S5596_011_0	1	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	011	0		29	10	S5596_011_0	1	Preferred Generic	4	001000	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5596	011	0		29	10	S5596_011_0	1	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	011	0		29	10	S5596_011_0	1	Generic	4	010000	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5596	011	0		29	10	S5596_011_0	1	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								45.00	90.00	135.00					25.00	50.00	75.00					25.00	75.00	75.00																45.00				45.00			1.50	0.83	0.83			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	011	0		29	10	S5596_011_0	1	Preferred Brand	4	000101	1	1	3	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34											98.89	60	60	60				97.24	59	59	59				60	60	60															60			60								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	1	
S5596	011	0		29	10	S5596_011_0	1	Non-Preferred Drug	4	100100	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34											89.17	40	40	40				78.02	35	35	35				35	35	35															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	011	0		29	10	S5596_011_0	1	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	011	0		29	10	S5596_011_0	1	Select Care Drugs	4	001000	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	011	0		29	10	S5596_011_0	1	Select Care Drugs	4	001000	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5596	013	0		29	10	S5596_013_0	1	Preferred Generic	3	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								18.00	36.00	54.00					2.00	4.00	6.00					2.00	6.00	6.00																18.00				18.00			0.60	0.07	0.07			0.53	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	013	0		29	10	S5596_013_0	1	Generic	3	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								20.00	40.00	60.00					7.00	14.00	21.00					7.00	21.00	21.00																20.00				20.00			0.67	0.23	0.23			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	013	0		29	10	S5596_013_0	1	Preferred Brand	3	000101	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					32.00	64.00	96.00					32.00	96.00	96.00																47.00				47.00			1.57	1.07	1.07			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	013	0		29	10	S5596_013_0	1	Non-Preferred Drug	3	100100	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34											61.72	50	50	50				49.38	40	40	40				40	40	40															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	013	0		29	10	S5596_013_0	1	Specialty Tier	3	010010	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	013	0		29	10	S5596_013_0	1	Select Care Drugs	3	001000	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	014	0		29	10	S5596_014_0	1	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					1.00	2.00	3.00					1.00	3.00	3.00																9.00				9.00			0.30	0.03	0.03			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	014	0		29	10	S5596_014_0	1	Preferred Generic	4	001000	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					1.00	2.00	3.00					1.00	3.00	3.00																9.00				9.00			0.30	0.03	0.03			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5596	014	0		29	10	S5596_014_0	1	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	014	0		29	10	S5596_014_0	1	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	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, Select Care Drugs												
S5596	014	0		29	10	S5596_014_0	1	Non-Preferred Drug	4	100100	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34											95.23	47	47	47				79.02	39	39	39				39	39	39															47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	014	0		29	10	S5596_014_0	1	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	014	0		29	10	S5596_014_0	1	Select Care Drugs	4	001000	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	014	0		29	10	S5596_014_0	1	Select Care Drugs	4	001000	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5596	015	0		29	10	S5596_015_0	1	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	015	0		29	10	S5596_015_0	1	Preferred Generic	4	001000	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5596	015	0		29	10	S5596_015_0	1	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	015	0		29	10	S5596_015_0	1	Generic	4	010000	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5596	015	0		29	10	S5596_015_0	1	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								45.00	90.00	135.00					25.00	50.00	75.00					25.00	75.00	75.00																45.00				45.00			1.50	0.83	0.83			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	015	0		29	10	S5596_015_0	1	Preferred Brand	4	000101	1	1	3	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34											106.79	60	60	60				105.01	59	59	59				60	60	60															60			60								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	1	
S5596	015	0		29	10	S5596_015_0	1	Non-Preferred Drug	4	100100	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34											85.66	40	40	40				74.96	35	35	35				35	35	35															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	015	0		29	10	S5596_015_0	1	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	015	0		29	10	S5596_015_0	1	Select Care Drugs	4	001000	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	015	0		29	10	S5596_015_0	1	Select Care Drugs	4	001000	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5596	017	0		29	10	S5596_017_0	1	Preferred Generic	3	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								16.00	32.00	48.00					1.00	2.00	3.00					1.00	3.00	3.00																16.00				16.00			0.53	0.03	0.03			0.47	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	017	0		29	10	S5596_017_0	1	Generic	3	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								20.00	40.00	60.00					5.00	10.00	15.00					5.00	15.00	15.00																20.00				20.00			0.67	0.17	0.17			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	017	0		29	10	S5596_017_0	1	Preferred Brand	3	000101	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								41.00	82.00	123.00					32.00	64.00	96.00					32.00	96.00	96.00																41.00				41.00			1.37	1.07	1.07			1.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	017	0		29	10	S5596_017_0	1	Non-Preferred Drug	3	100100	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34											56.56	50	50	50				45.25	40	40	40				40	40	40															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	017	0		29	10	S5596_017_0	1	Specialty Tier	3	010010	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	017	0		29	10	S5596_017_0	1	Select Care Drugs	3	001000	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	018	0		29	10	S5596_018_0	1	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					1.00	2.00	3.00					1.00	3.00	3.00																9.00				9.00			0.30	0.03	0.03			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	018	0		29	10	S5596_018_0	1	Preferred Generic	4	001000	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					1.00	2.00	3.00					1.00	3.00	3.00																9.00				9.00			0.30	0.03	0.03			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5596	018	0		29	10	S5596_018_0	1	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	018	0		29	10	S5596_018_0	1	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	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, Select Care Drugs												
S5596	018	0		29	10	S5596_018_0	1	Non-Preferred Drug	4	100100	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34											81.33	47	47	47				67.49	39	39	39				39	39	39															47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	018	0		29	10	S5596_018_0	1	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	018	0		29	10	S5596_018_0	1	Select Care Drugs	4	001000	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	018	0		29	10	S5596_018_0	1	Select Care Drugs	4	001000	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5596	019	0		29	10	S5596_019_0	1	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	019	0		29	10	S5596_019_0	1	Preferred Generic	4	001000	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5596	019	0		29	10	S5596_019_0	1	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	019	0		29	10	S5596_019_0	1	Generic	4	010000	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5596	019	0		29	10	S5596_019_0	1	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								45.00	90.00	135.00					25.00	50.00	75.00					25.00	75.00	75.00																45.00				45.00			1.50	0.83	0.83			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	019	0		29	10	S5596_019_0	1	Preferred Brand	4	000101	1	1	3	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34											96.38	60	60	60				94.78	59	59	59				60	60	60															60			60								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	1	
S5596	019	0		29	10	S5596_019_0	1	Non-Preferred Drug	4	100100	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34											77.15	40	40	40				67.51	35	35	35				35	35	35															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	019	0		29	10	S5596_019_0	1	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	019	0		29	10	S5596_019_0	1	Select Care Drugs	4	001000	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	019	0		29	10	S5596_019_0	1	Select Care Drugs	4	001000	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5596	033	0		29	10	S5596_033_0	1	Preferred Generic	3	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								11.00	22.00	33.00					1.00	2.00	3.00					1.00	3.00	3.00																11.00				11.00			0.37	0.03	0.03			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	033	0		29	10	S5596_033_0	1	Generic	3	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					5.00	10.00	15.00					5.00	15.00	15.00																17.00				17.00			0.57	0.17	0.17			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	033	0		29	10	S5596_033_0	1	Preferred Brand	3	000101	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								41.00	82.00	123.00					32.00	64.00	96.00					32.00	96.00	96.00																41.00				41.00			1.37	1.07	1.07			1.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	033	0		29	10	S5596_033_0	1	Non-Preferred Drug	3	100100	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34											65.50	48	48	48				54.58	40	40	40				40	40	40															48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	033	0		29	10	S5596_033_0	1	Specialty Tier	3	010010	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	033	0		29	10	S5596_033_0	1	Select Care Drugs	3	001000	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	034	0		29	10	S5596_034_0	1	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					1.00	2.00	3.00					1.00	3.00	3.00																9.00				9.00			0.30	0.03	0.03			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	034	0		29	10	S5596_034_0	1	Preferred Generic	4	001000	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					1.00	2.00	3.00					1.00	3.00	3.00																9.00				9.00			0.30	0.03	0.03			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5596	034	0		29	10	S5596_034_0	1	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	034	0		29	10	S5596_034_0	1	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	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, Select Care Drugs												
S5596	034	0		29	10	S5596_034_0	1	Non-Preferred Drug	4	100100	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34											95.44	47	47	47				79.20	39	39	39				39	39	39															47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	034	0		29	10	S5596_034_0	1	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	034	0		29	10	S5596_034_0	1	Select Care Drugs	4	001000	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	034	0		29	10	S5596_034_0	1	Select Care Drugs	4	001000	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5596	035	0		29	10	S5596_035_0	1	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	035	0		29	10	S5596_035_0	1	Preferred Generic	4	001000	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5596	035	0		29	10	S5596_035_0	1	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	035	0		29	10	S5596_035_0	1	Generic	4	010000	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5596	035	0		29	10	S5596_035_0	1	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								45.00	90.00	135.00					25.00	50.00	75.00					25.00	75.00	75.00																45.00				45.00			1.50	0.83	0.83			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	035	0		29	10	S5596_035_0	1	Preferred Brand	4	000101	1	1	3	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34											104.68	60	60	60				102.94	59	59	59				60	60	60															60			60								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	1	
S5596	035	0		29	10	S5596_035_0	1	Non-Preferred Drug	4	100100	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34											91.56	40	40	40				80.12	35	35	35				35	35	35															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	035	0		29	10	S5596_035_0	1	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	035	0		29	10	S5596_035_0	1	Select Care Drugs	4	001000	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	035	0		29	10	S5596_035_0	1	Select Care Drugs	4	001000	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5596	043	0		29	10	S5596_043_0	1	Preferred Generic	3	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					1.00	2.00	3.00					1.00	3.00	3.00																9.00				9.00			0.30	0.03	0.03			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	043	0		29	10	S5596_043_0	1	Generic	3	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								15.00	30.00	45.00					5.00	10.00	15.00					5.00	15.00	15.00																15.00				15.00			0.50	0.17	0.17			0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	043	0		29	10	S5596_043_0	1	Preferred Brand	3	000101	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								39.00	78.00	117.00					32.00	64.00	96.00					32.00	96.00	96.00																39.00				39.00			1.30	1.07	1.07			1.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	043	0		29	10	S5596_043_0	1	Non-Preferred Drug	3	100100	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34											55.59	47	47	47				47.31	40	40	40				40	40	40															47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	043	0		29	10	S5596_043_0	1	Specialty Tier	3	010010	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	043	0		29	10	S5596_043_0	1	Select Care Drugs	3	001000	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	044	0		29	10	S5596_044_0	1	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					1.00	2.00	3.00					1.00	3.00	3.00																9.00				9.00			0.30	0.03	0.03			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	044	0		29	10	S5596_044_0	1	Preferred Generic	4	001000	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					1.00	2.00	3.00					1.00	3.00	3.00																9.00				9.00			0.30	0.03	0.03			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5596	044	0		29	10	S5596_044_0	1	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	044	0		29	10	S5596_044_0	1	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	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, Select Care Drugs												
S5596	044	0		29	10	S5596_044_0	1	Non-Preferred Drug	4	100100	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34											83.32	47	47	47				69.14	39	39	39				39	39	39															47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	044	0		29	10	S5596_044_0	1	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	044	0		29	10	S5596_044_0	1	Select Care Drugs	4	001000	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	044	0		29	10	S5596_044_0	1	Select Care Drugs	4	001000	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5596	045	0		29	10	S5596_045_0	1	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	045	0		29	10	S5596_045_0	1	Preferred Generic	4	001000	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5596	045	0		29	10	S5596_045_0	1	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	045	0		29	10	S5596_045_0	1	Generic	4	010000	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5596	045	0		29	10	S5596_045_0	1	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								45.00	90.00	135.00					25.00	50.00	75.00					25.00	75.00	75.00																45.00				45.00			1.50	0.83	0.83			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	045	0		29	10	S5596_045_0	1	Preferred Brand	4	000101	1	1	3	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34											98.00	60	60	60				96.37	59	59	59				60	60	60															60			60								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	1	
S5596	045	0		29	10	S5596_045_0	1	Non-Preferred Drug	4	100100	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34											79.00	40	40	40				69.13	35	35	35				35	35	35															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	045	0		29	10	S5596_045_0	1	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	045	0		29	10	S5596_045_0	1	Select Care Drugs	4	001000	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	045	0		29	10	S5596_045_0	1	Select Care Drugs	4	001000	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5596	046	0		29	10	S5596_046_0	1	Preferred Generic	3	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								19.00	38.00	57.00					2.00	4.00	6.00					2.00	6.00	6.00																19.00				19.00			0.63	0.07	0.07			0.56	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	046	0		29	10	S5596_046_0	1	Generic	3	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								20.00	40.00	60.00					7.00	14.00	21.00					7.00	21.00	21.00																20.00				20.00			0.67	0.23	0.23			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	046	0		29	10	S5596_046_0	1	Preferred Brand	3	000101	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					32.00	64.00	96.00					32.00	96.00	96.00																47.00				47.00			1.57	1.07	1.07			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	046	0		29	10	S5596_046_0	1	Non-Preferred Drug	3	100100	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34											64.08	50	50	50				51.26	40	40	40				40	40	40															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	046	0		29	10	S5596_046_0	1	Specialty Tier	3	010010	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	046	0		29	10	S5596_046_0	1	Select Care Drugs	3	001000	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								8.00	16.00	24.00					0.00	0.00	0.00					0.00	0.00	0.00																8.00				8.00			0.27	0.00	0.00			0.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	056	0		29	10	S5596_056_0	1	Preferred Generic	3	001000	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	3.00	3.00																19.00				19.00			0.63	0.03	0.03			0.56	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	056	0		29	10	S5596_056_0	1	Generic	3	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								20.00	40.00	60.00					5.00	10.00	15.00					5.00	15.00	15.00																20.00				20.00			0.67	0.17	0.17			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	056	0		29	10	S5596_056_0	1	Preferred Brand	3	000101	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								38.00	76.00	114.00					32.00	64.00	96.00					32.00	96.00	96.00																38.00				38.00			1.27	1.07	1.07			1.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	056	0		29	10	S5596_056_0	1	Non-Preferred Drug	3	100100	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34											50.50	43	43	43				46.98	40	40	40				40	40	40															43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	056	0		29	10	S5596_056_0	1	Specialty Tier	3	010010	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	056	0		29	10	S5596_056_0	1	Select Care Drugs	3	001000	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	057	0		29	10	S5596_057_0	1	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					1.00	2.00	3.00					1.00	3.00	3.00																9.00				9.00			0.30	0.03	0.03			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	057	0		29	10	S5596_057_0	1	Preferred Generic	4	001000	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					1.00	2.00	3.00					1.00	3.00	3.00																9.00				9.00			0.30	0.03	0.03			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5596	057	0		29	10	S5596_057_0	1	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	057	0		29	10	S5596_057_0	1	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	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, Select Care Drugs												
S5596	057	0		29	10	S5596_057_0	1	Non-Preferred Drug	4	100100	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34											81.80	47	47	47				67.87	39	39	39				39	39	39															47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	057	0		29	10	S5596_057_0	1	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	057	0		29	10	S5596_057_0	1	Select Care Drugs	4	001000	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	057	0		29	10	S5596_057_0	1	Select Care Drugs	4	001000	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5596	058	0		29	10	S5596_058_0	1	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	058	0		29	10	S5596_058_0	1	Preferred Generic	4	001000	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5596	058	0		29	10	S5596_058_0	1	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	058	0		29	10	S5596_058_0	1	Generic	4	010000	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5596	058	0		29	10	S5596_058_0	1	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								45.00	90.00	135.00					25.00	50.00	75.00					25.00	75.00	75.00																45.00				45.00			1.50	0.83	0.83			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	058	0		29	10	S5596_058_0	1	Preferred Brand	4	000101	1	1	3	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34											108.51	60	60	60				106.70	59	59	59				60	60	60															60			60								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	1	
S5596	058	0		29	10	S5596_058_0	1	Non-Preferred Drug	4	100100	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34											82.57	40	40	40				72.25	35	35	35				35	35	35															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	058	0		29	10	S5596_058_0	1	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	058	0		29	10	S5596_058_0	1	Select Care Drugs	4	001000	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	058	0		29	10	S5596_058_0	1	Select Care Drugs	4	001000	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5596	059	0		29	10	S5596_059_0	1	Preferred Generic	3	001000	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	3.00	3.00																19.00				19.00			0.63	0.03	0.03			0.56	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	059	0		29	10	S5596_059_0	1	Generic	3	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								20.00	40.00	60.00					6.00	12.00	18.00					6.00	18.00	18.00																20.00				20.00			0.67	0.20	0.20			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	059	0		29	10	S5596_059_0	1	Preferred Brand	3	000101	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					32.00	64.00	96.00					32.00	96.00	96.00																47.00				47.00			1.57	1.07	1.07			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	059	0		29	10	S5596_059_0	1	Non-Preferred Drug	3	100100	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34											62.80	50	50	50				50.24	40	40	40				40	40	40															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	059	0		29	10	S5596_059_0	1	Specialty Tier	3	010010	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	059	0		29	10	S5596_059_0	1	Select Care Drugs	3	001000	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	060	0		29	10	S5596_060_0	1	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					1.00	2.00	3.00					1.00	3.00	3.00																9.00				9.00			0.30	0.03	0.03			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	060	0		29	10	S5596_060_0	1	Preferred Generic	4	001000	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					1.00	2.00	3.00					1.00	3.00	3.00																9.00				9.00			0.30	0.03	0.03			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5596	060	0		29	10	S5596_060_0	1	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	060	0		29	10	S5596_060_0	1	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	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, Select Care Drugs												
S5596	060	0		29	10	S5596_060_0	1	Non-Preferred Drug	4	100100	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34											93.35	47	47	47				77.46	39	39	39				39	39	39															47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	060	0		29	10	S5596_060_0	1	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	060	0		29	10	S5596_060_0	1	Select Care Drugs	4	001000	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	060	0		29	10	S5596_060_0	1	Select Care Drugs	4	001000	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5596	061	0		29	10	S5596_061_0	1	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	061	0		29	10	S5596_061_0	1	Preferred Generic	4	001000	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5596	061	0		29	10	S5596_061_0	1	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	061	0		29	10	S5596_061_0	1	Generic	4	010000	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5596	061	0		29	10	S5596_061_0	1	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								45.00	90.00	135.00					25.00	50.00	75.00					25.00	75.00	75.00																45.00				45.00			1.50	0.83	0.83			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	061	0		29	10	S5596_061_0	1	Preferred Brand	4	000101	1	1	3	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34											102.88	60	60	60				101.17	59	59	59				60	60	60															60			60								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	1	
S5596	061	0		29	10	S5596_061_0	1	Non-Preferred Drug	4	100100	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34											88.28	40	40	40				77.25	35	35	35				35	35	35															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	061	0		29	10	S5596_061_0	1	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	061	0		29	10	S5596_061_0	1	Select Care Drugs	4	001000	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	061	0		29	10	S5596_061_0	1	Select Care Drugs	4	001000	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5596	062	0		29	10	S5596_062_0	1	Preferred Generic	3	001000	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	3.00	3.00																19.00				19.00			0.63	0.03	0.03			0.56	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	062	0		29	10	S5596_062_0	1	Generic	3	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								20.00	40.00	60.00					7.00	14.00	21.00					7.00	21.00	21.00																20.00				20.00			0.67	0.23	0.23			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	062	0		29	10	S5596_062_0	1	Preferred Brand	3	000101	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					40.00	80.00	120.00					40.00	120.00	120.00																47.00				47.00			1.57	1.33	1.33			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	062	0		29	10	S5596_062_0	1	Non-Preferred Drug	3	100100	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34											52.54	50	50	50				48.34	46	46	46				46	46	46															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	062	0		29	10	S5596_062_0	1	Specialty Tier	3	010010	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	062	0		29	10	S5596_062_0	1	Select Care Drugs	3	001000	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								11.00	22.00	33.00					0.00	0.00	0.00					0.00	0.00	0.00																11.00				11.00			0.37	0.00	0.00			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	063	0		29	10	S5596_063_0	1	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					1.00	2.00	3.00					1.00	3.00	3.00																9.00				9.00			0.30	0.03	0.03			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	063	0		29	10	S5596_063_0	1	Preferred Generic	4	001000	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					1.00	2.00	3.00					1.00	3.00	3.00																9.00				9.00			0.30	0.03	0.03			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5596	063	0		29	10	S5596_063_0	1	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	063	0		29	10	S5596_063_0	1	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	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, Select Care Drugs												
S5596	063	0		29	10	S5596_063_0	1	Non-Preferred Drug	4	100100	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34											98.39	47	47	47				81.64	39	39	39				39	39	39															47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	063	0		29	10	S5596_063_0	1	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	063	0		29	10	S5596_063_0	1	Select Care Drugs	4	001000	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	063	0		29	10	S5596_063_0	1	Select Care Drugs	4	001000	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5596	064	0		29	10	S5596_064_0	1	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	064	0		29	10	S5596_064_0	1	Preferred Generic	4	001000	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5596	064	0		29	10	S5596_064_0	1	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	064	0		29	10	S5596_064_0	1	Generic	4	010000	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5596	064	0		29	10	S5596_064_0	1	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								45.00	90.00	135.00					25.00	50.00	75.00					25.00	75.00	75.00																45.00				45.00			1.50	0.83	0.83			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	064	0		29	10	S5596_064_0	1	Preferred Brand	4	000101	1	1	3	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34											111.56	60	60	60				109.70	59	59	59				60	60	60															60			60								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	1	
S5596	064	0		29	10	S5596_064_0	1	Non-Preferred Drug	4	100100	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34											91.05	40	40	40				79.66	35	35	35				35	35	35															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	064	0		29	10	S5596_064_0	1	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	064	0		29	10	S5596_064_0	1	Select Care Drugs	4	001000	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5596	064	0		29	10	S5596_064_0	1	Select Care Drugs	4	001000	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5601	002	0		29	10	S5601_002_0	4	Preferred Generic	3	001001	1	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	3.00	6.00	7.50																									3.00	6.00	9.00				3.00	6.00	7.50				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	002	0		29	10	S5601_002_0	4	Generic	3	010001	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	17.00	34.00	42.50																									17.00	34.00	51.00				17.00	34.00	42.50				17.00				17.00		0.57				0.57	0.57	0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	002	0		29	10	S5601_002_0	4	Preferred Brand	3	000101	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	46.00	92.00	115.00																									46.00	92.00	138.00				46.00	92.00	115.00				46.00				46.00		1.53				1.53	1.53	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	002	0		29	10	S5601_002_0	4	Non-Preferred Drug	3	100100	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34				87.64	50	50	50																								50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	002	0		29	10	S5601_002_0	4	Specialty Tier	3	010010	1	1	5	1	010		01		010	1	30											30			30		34				625.43	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	003	0		29	10	S5601_003_0	3	Preferred Generic	4	001001	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	003	0		29	10	S5601_003_0	3	Preferred Generic	4	001001	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5601	003	0		29	10	S5601_003_0	3	Generic	4	010001	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					3.00	6.00	7.50											20.00	40.00	60.00				3.00	6.00	0.00				20.00				20.00			0.67	0.10		0.67	0.10	0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	003	0		29	10	S5601_003_0	3	Generic	4	010001	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					3.00	6.00	7.50											20.00	40.00	60.00				3.00	6.00	0.00				20.00				20.00			0.67	0.10		0.67	0.10	0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5601	003	0		29	10	S5601_003_0	3	Preferred Brand	4	000101	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					27.00	54.00	67.50											47.00	94.00	141.00				27.00	54.00	67.50				47.00				47.00			1.57	0.90		1.57	0.90	1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	003	0		29	10	S5601_003_0	3	Non-Preferred Drug	4	100100	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											73.50	50	50	50				58.80	40	40	40										50	50	50				40	40	40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	003	0		29	10	S5601_003_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		34											355.08	33						355.08	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	004	0		29	10	S5601_004_0	3	Preferred Generic	3	001001	1	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	3.00	6.00	7.50																									3.00	6.00	9.00				3.00	6.00	7.50				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	004	0		29	10	S5601_004_0	3	Generic	3	010001	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	13.00	26.00	32.50																									13.00	26.00	39.00				13.00	26.00	32.50				13.00				13.00		0.43				0.43	0.43	0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	004	0		29	10	S5601_004_0	3	Preferred Brand	3	000101	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	42.00	84.00	105.00																									42.00	84.00	126.00				42.00	84.00	105.00				42.00				42.00		1.40				1.40	1.40	1.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	004	0		29	10	S5601_004_0	3	Non-Preferred Drug	3	100100	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34				78.56	44	44	44																								44	44	44				44	44	44			44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	004	0		29	10	S5601_004_0	3	Specialty Tier	3	010010	1	1	5	1	010		01		010	1	30											30			30		34				590.40	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	005	0		29	10	S5601_005_0	2	Preferred Generic	4	001001	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	005	0		29	10	S5601_005_0	2	Preferred Generic	4	001001	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5601	005	0		29	10	S5601_005_0	2	Generic	4	010001	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					3.00	6.00	7.50											20.00	40.00	60.00				3.00	6.00	0.00				20.00				20.00			0.67	0.10		0.67	0.10	0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	005	0		29	10	S5601_005_0	2	Generic	4	010001	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					3.00	6.00	7.50											20.00	40.00	60.00				3.00	6.00	0.00				20.00				20.00			0.67	0.10		0.67	0.10	0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5601	005	0		29	10	S5601_005_0	2	Preferred Brand	4	000101	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					27.00	54.00	67.50											47.00	94.00	141.00				27.00	54.00	67.50				47.00				47.00			1.57	0.90		1.57	0.90	1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	005	0		29	10	S5601_005_0	2	Non-Preferred Drug	4	100100	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											84.54	50	50	50				67.64	40	40	40										50	50	50				40	40	40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	005	0		29	10	S5601_005_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		34											425.85	33						425.85	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	006	0		29	10	S5601_006_0	3	Preferred Generic	3	001001	1	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	3.00	6.00	7.50																									3.00	6.00	9.00				3.00	6.00	7.50				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	006	0		29	10	S5601_006_0	3	Generic	3	010001	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	13.00	26.00	32.50																									13.00	26.00	39.00				13.00	26.00	32.50				13.00				13.00		0.43				0.43	0.43	0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	006	0		29	10	S5601_006_0	3	Preferred Brand	3	000101	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	46.00	92.00	115.00																									46.00	92.00	138.00				46.00	92.00	115.00				46.00				46.00		1.53				1.53	1.53	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	006	0		29	10	S5601_006_0	3	Non-Preferred Drug	3	100100	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34				85.54	48	48	48																								48	48	48				48	48	48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	006	0		29	10	S5601_006_0	3	Specialty Tier	3	010010	1	1	5	1	010		01		010	1	30											30			30		34				490.60	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	007	0		29	10	S5601_007_0	2	Preferred Generic	4	001001	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	007	0		29	10	S5601_007_0	2	Preferred Generic	4	001001	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5601	007	0		29	10	S5601_007_0	2	Generic	4	010001	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					3.00	6.00	7.50											20.00	40.00	60.00				3.00	6.00	0.00				20.00				20.00			0.67	0.10		0.67	0.10	0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	007	0		29	10	S5601_007_0	2	Generic	4	010001	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					3.00	6.00	7.50											20.00	40.00	60.00				3.00	6.00	0.00				20.00				20.00			0.67	0.10		0.67	0.10	0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5601	007	0		29	10	S5601_007_0	2	Preferred Brand	4	000101	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					27.00	54.00	67.50											47.00	94.00	141.00				27.00	54.00	67.50				47.00				47.00			1.57	0.90		1.57	0.90	1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	007	0		29	10	S5601_007_0	2	Non-Preferred Drug	4	100100	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											86.25	50	50	50				69.00	40	40	40										50	50	50				40	40	40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	007	0		29	10	S5601_007_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		34											522.52	33						522.52	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	008	0		29	10	S5601_008_0	3	Preferred Generic	3	001001	1	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	3.00	6.00	7.50																									3.00	6.00	9.00				3.00	6.00	7.50				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	008	0		29	10	S5601_008_0	3	Generic	3	010001	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	15.00	30.00	37.50																									15.00	30.00	45.00				15.00	30.00	37.50				15.00				15.00		0.50				0.50	0.50	0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	008	0		29	10	S5601_008_0	3	Preferred Brand	3	000101	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	47.00	94.00	117.50																									47.00	94.00	141.00				47.00	94.00	117.50				47.00				47.00		1.57				1.57	1.57	1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	008	0		29	10	S5601_008_0	3	Non-Preferred Drug	3	100100	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34				90.11	49	49	49																								49	49	49				49	49	49			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	008	0		29	10	S5601_008_0	3	Specialty Tier	3	010010	1	1	5	1	010		01		010	1	30											30			30		34				525.39	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	009	0		29	10	S5601_009_0	2	Preferred Generic	4	001001	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	009	0		29	10	S5601_009_0	2	Preferred Generic	4	001001	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5601	009	0		29	10	S5601_009_0	2	Generic	4	010001	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					3.00	6.00	7.50											20.00	40.00	60.00				3.00	6.00	0.00				20.00				20.00			0.67	0.10		0.67	0.10	0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	009	0		29	10	S5601_009_0	2	Generic	4	010001	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					3.00	6.00	7.50											20.00	40.00	60.00				3.00	6.00	0.00				20.00				20.00			0.67	0.10		0.67	0.10	0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5601	009	0		29	10	S5601_009_0	2	Preferred Brand	4	000101	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					27.00	54.00	67.50											47.00	94.00	141.00				27.00	54.00	67.50				47.00				47.00			1.57	0.90		1.57	0.90	1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	009	0		29	10	S5601_009_0	2	Non-Preferred Drug	4	100100	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											89.11	50	50	50				71.29	40	40	40										50	50	50				40	40	40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	009	0		29	10	S5601_009_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		34											437.25	33						437.25	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	010	0		29	10	S5601_010_0	3	Preferred Generic	3	001001	1	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	3.00	6.00	7.50																									3.00	6.00	9.00				3.00	6.00	7.50				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	010	0		29	10	S5601_010_0	3	Generic	3	010001	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	19.00	38.00	47.50																									19.00	38.00	57.00				19.00	38.00	47.50				19.00				19.00		0.63				0.63	0.63	0.56	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	010	0		29	10	S5601_010_0	3	Preferred Brand	3	000101	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	47.00	94.00	117.50																									47.00	94.00	141.00				47.00	94.00	117.50				47.00				47.00		1.57				1.57	1.57	1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	010	0		29	10	S5601_010_0	3	Non-Preferred Drug	3	100100	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34				87.44	50	50	50																								50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	010	0		29	10	S5601_010_0	3	Specialty Tier	3	010010	1	1	5	1	010		01		010	1	30											30			30		34				589.06	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	011	0		29	10	S5601_011_0	2	Preferred Generic	4	001001	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	011	0		29	10	S5601_011_0	2	Preferred Generic	4	001001	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5601	011	0		29	10	S5601_011_0	2	Generic	4	010001	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					3.00	6.00	7.50											20.00	40.00	60.00				3.00	6.00	0.00				20.00				20.00			0.67	0.10		0.67	0.10	0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	011	0		29	10	S5601_011_0	2	Generic	4	010001	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					3.00	6.00	7.50											20.00	40.00	60.00				3.00	6.00	0.00				20.00				20.00			0.67	0.10		0.67	0.10	0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5601	011	0		29	10	S5601_011_0	2	Preferred Brand	4	000101	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					27.00	54.00	67.50											47.00	94.00	141.00				27.00	54.00	67.50				47.00				47.00			1.57	0.90		1.57	0.90	1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	011	0		29	10	S5601_011_0	2	Non-Preferred Drug	4	100100	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											83.54	50	50	50				66.83	40	40	40										50	50	50				40	40	40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	011	0		29	10	S5601_011_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		34											492.07	33						492.07	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	012	0		29	10	S5601_012_0	3	Preferred Generic	3	001001	1	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	3.00	6.00	7.50																									3.00	6.00	9.00				3.00	6.00	7.50				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	012	0		29	10	S5601_012_0	3	Generic	3	010001	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	13.00	26.00	32.50																									13.00	26.00	39.00				13.00	26.00	32.50				13.00				13.00		0.43				0.43	0.43	0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	012	0		29	10	S5601_012_0	3	Preferred Brand	3	000101	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	45.00	90.00	112.50																									45.00	90.00	135.00				45.00	90.00	112.50				45.00				45.00		1.50				1.50	1.50	1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	012	0		29	10	S5601_012_0	3	Non-Preferred Drug	3	100100	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34				82.59	50	50	50																								50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	012	0		29	10	S5601_012_0	3	Specialty Tier	3	010010	1	1	5	1	010		01		010	1	30											30			30		34				351.32	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	013	0		29	10	S5601_013_0	2	Preferred Generic	4	001001	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	013	0		29	10	S5601_013_0	2	Preferred Generic	4	001001	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5601	013	0		29	10	S5601_013_0	2	Generic	4	010001	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					3.00	6.00	7.50											20.00	40.00	60.00				3.00	6.00	0.00				20.00				20.00			0.67	0.10		0.67	0.10	0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	013	0		29	10	S5601_013_0	2	Generic	4	010001	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					3.00	6.00	7.50											20.00	40.00	60.00				3.00	6.00	0.00				20.00				20.00			0.67	0.10		0.67	0.10	0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5601	013	0		29	10	S5601_013_0	2	Preferred Brand	4	000101	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					27.00	54.00	67.50											47.00	94.00	141.00				27.00	54.00	67.50				47.00				47.00			1.57	0.90		1.57	0.90	1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	013	0		29	10	S5601_013_0	2	Non-Preferred Drug	4	100100	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											78.33	50	50	50				62.66	40	40	40										50	50	50				40	40	40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	013	0		29	10	S5601_013_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		34											310.70	33						310.70	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	014	0		29	10	S5601_014_0	3	Preferred Generic	3	001001	1	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	3.00	6.00	7.50																									3.00	6.00	9.00				3.00	6.00	7.50				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	014	0		29	10	S5601_014_0	3	Generic	3	010001	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	18.00	36.00	45.00																									18.00	36.00	54.00				18.00	36.00	45.00				18.00				18.00		0.60				0.60	0.60	0.53	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	014	0		29	10	S5601_014_0	3	Preferred Brand	3	000101	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	47.00	94.00	117.50																									47.00	94.00	141.00				47.00	94.00	117.50				47.00				47.00		1.57				1.57	1.57	1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	014	0		29	10	S5601_014_0	3	Non-Preferred Drug	3	100100	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34				81.04	50	50	50																								50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	014	0		29	10	S5601_014_0	3	Specialty Tier	3	010010	1	1	5	1	010		01		010	1	30											30			30		34				415.33	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	015	0		29	10	S5601_015_0	2	Preferred Generic	4	001001	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	015	0		29	10	S5601_015_0	2	Preferred Generic	4	001001	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5601	015	0		29	10	S5601_015_0	2	Generic	4	010001	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					3.00	6.00	7.50											20.00	40.00	60.00				3.00	6.00	0.00				20.00				20.00			0.67	0.10		0.67	0.10	0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	015	0		29	10	S5601_015_0	2	Generic	4	010001	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					3.00	6.00	7.50											20.00	40.00	60.00				3.00	6.00	0.00				20.00				20.00			0.67	0.10		0.67	0.10	0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5601	015	0		29	10	S5601_015_0	2	Preferred Brand	4	000101	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					27.00	54.00	67.50											47.00	94.00	141.00				27.00	54.00	67.50				47.00				47.00			1.57	0.90		1.57	0.90	1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	015	0		29	10	S5601_015_0	2	Non-Preferred Drug	4	100100	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											72.80	50	50	50				58.24	40	40	40										50	50	50				40	40	40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	015	0		29	10	S5601_015_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		34											315.26	33						315.26	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	016	0		29	10	S5601_016_0	3	Preferred Generic	3	001001	1	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	3.00	6.00	7.50																									3.00	6.00	9.00				3.00	6.00	7.50				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	016	0		29	10	S5601_016_0	3	Generic	3	010001	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	14.00	28.00	35.00																									14.00	28.00	42.00				14.00	28.00	35.00				14.00				14.00		0.47				0.47	0.47	0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	016	0		29	10	S5601_016_0	3	Preferred Brand	3	000101	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	45.00	90.00	112.50																									45.00	90.00	135.00				45.00	90.00	112.50				45.00				45.00		1.50				1.50	1.50	1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	016	0		29	10	S5601_016_0	3	Non-Preferred Drug	3	100100	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34				84.48	50	50	50																								50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	016	0		29	10	S5601_016_0	3	Specialty Tier	3	010010	1	1	5	1	010		01		010	1	30											30			30		34				431.34	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	017	0		29	10	S5601_017_0	2	Preferred Generic	4	001001	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	017	0		29	10	S5601_017_0	2	Preferred Generic	4	001001	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5601	017	0		29	10	S5601_017_0	2	Generic	4	010001	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					3.00	6.00	7.50											20.00	40.00	60.00				3.00	6.00	0.00				20.00				20.00			0.67	0.10		0.67	0.10	0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	017	0		29	10	S5601_017_0	2	Generic	4	010001	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					3.00	6.00	7.50											20.00	40.00	60.00				3.00	6.00	0.00				20.00				20.00			0.67	0.10		0.67	0.10	0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5601	017	0		29	10	S5601_017_0	2	Preferred Brand	4	000101	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					27.00	54.00	67.50											47.00	94.00	141.00				27.00	54.00	67.50				47.00				47.00			1.57	0.90		1.57	0.90	1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	017	0		29	10	S5601_017_0	2	Non-Preferred Drug	4	100100	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											69.72	50	50	50				55.77	40	40	40										50	50	50				40	40	40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	017	0		29	10	S5601_017_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		34											329.55	33						329.55	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	018	0		29	10	S5601_018_0	3	Preferred Generic	3	001001	1	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	3.00	6.00	7.50																									3.00	6.00	9.00				3.00	6.00	7.50				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	018	0		29	10	S5601_018_0	3	Generic	3	010001	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	17.00	34.00	42.50																									17.00	34.00	51.00				17.00	34.00	42.50				17.00				17.00		0.57				0.57	0.57	0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	018	0		29	10	S5601_018_0	3	Preferred Brand	3	000101	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	47.00	94.00	117.50																									47.00	94.00	141.00				47.00	94.00	117.50				47.00				47.00		1.57				1.57	1.57	1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	018	0		29	10	S5601_018_0	3	Non-Preferred Drug	3	100100	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34				75.68	50	50	50																								50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	018	0		29	10	S5601_018_0	3	Specialty Tier	3	010010	1	1	5	1	010		01		010	1	30											30			30		34				441.64	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	019	0		29	10	S5601_019_0	2	Preferred Generic	4	001001	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	019	0		29	10	S5601_019_0	2	Preferred Generic	4	001001	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5601	019	0		29	10	S5601_019_0	2	Generic	4	010001	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					3.00	6.00	7.50											20.00	40.00	60.00				3.00	6.00	0.00				20.00				20.00			0.67	0.10		0.67	0.10	0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	019	0		29	10	S5601_019_0	2	Generic	4	010001	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					3.00	6.00	7.50											20.00	40.00	60.00				3.00	6.00	0.00				20.00				20.00			0.67	0.10		0.67	0.10	0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5601	019	0		29	10	S5601_019_0	2	Preferred Brand	4	000101	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					33.00	66.00	82.50											47.00	94.00	141.00				33.00	66.00	82.50				47.00				47.00			1.57	1.10		1.57	1.10	1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	019	0		29	10	S5601_019_0	2	Non-Preferred Drug	4	100100	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											68.94	50	50	50				62.05	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	019	0		29	10	S5601_019_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		34											256.74	33						256.74	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	020	0		29	10	S5601_020_0	3	Preferred Generic	3	001001	1	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	3.00	6.00	7.50																									3.00	6.00	9.00				3.00	6.00	7.50				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	020	0		29	10	S5601_020_0	3	Generic	3	010001	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	13.00	26.00	32.50																									13.00	26.00	39.00				13.00	26.00	32.50				13.00				13.00		0.43				0.43	0.43	0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	020	0		29	10	S5601_020_0	3	Preferred Brand	3	000101	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	46.00	92.00	115.00																									46.00	92.00	138.00				46.00	92.00	115.00				46.00				46.00		1.53				1.53	1.53	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	020	0		29	10	S5601_020_0	3	Non-Preferred Drug	3	100100	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34				75.86	50	50	50																								50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	020	0		29	10	S5601_020_0	3	Specialty Tier	3	010010	1	1	5	1	010		01		010	1	30											30			30		34				416.50	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	021	0		29	10	S5601_021_0	2	Preferred Generic	4	001001	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	021	0		29	10	S5601_021_0	2	Preferred Generic	4	001001	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5601	021	0		29	10	S5601_021_0	2	Generic	4	010001	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					3.00	6.00	7.50											20.00	40.00	60.00				3.00	6.00	0.00				20.00				20.00			0.67	0.10		0.67	0.10	0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	021	0		29	10	S5601_021_0	2	Generic	4	010001	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					3.00	6.00	7.50											20.00	40.00	60.00				3.00	6.00	0.00				20.00				20.00			0.67	0.10		0.67	0.10	0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5601	021	0		29	10	S5601_021_0	2	Preferred Brand	4	000101	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					33.00	66.00	82.50											47.00	94.00	141.00				33.00	66.00	82.50				47.00				47.00			1.57	1.10		1.57	1.10	1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	021	0		29	10	S5601_021_0	2	Non-Preferred Drug	4	100100	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											68.85	50	50	50				61.97	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	021	0		29	10	S5601_021_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		34											275.66	33						275.66	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	022	0		29	10	S5601_022_0	3	Preferred Generic	3	001001	1	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	4.00	8.00	10.00																									4.00	8.00	12.00				4.00	8.00	10.00				4.00				4.00		0.13				0.13	0.13	0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	022	0		29	10	S5601_022_0	3	Generic	3	010001	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	20.00	40.00	50.00																									20.00	40.00	60.00				20.00	40.00	50.00				20.00				20.00		0.67				0.67	0.67	0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	022	0		29	10	S5601_022_0	3	Preferred Brand	3	000101	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	47.00	94.00	117.50																									47.00	94.00	141.00				47.00	94.00	117.50				47.00				47.00		1.57				1.57	1.57	1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	022	0		29	10	S5601_022_0	3	Non-Preferred Drug	3	100100	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34				80.88	50	50	50																								50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	022	0		29	10	S5601_022_0	3	Specialty Tier	3	010010	1	1	5	1	010		01		010	1	30											30			30		34				546.27	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	023	0		29	10	S5601_023_0	2	Preferred Generic	4	001001	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	023	0		29	10	S5601_023_0	2	Preferred Generic	4	001001	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5601	023	0		29	10	S5601_023_0	2	Generic	4	010001	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					3.00	6.00	7.50											20.00	40.00	60.00				3.00	6.00	0.00				20.00				20.00			0.67	0.10		0.67	0.10	0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	023	0		29	10	S5601_023_0	2	Generic	4	010001	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					3.00	6.00	7.50											20.00	40.00	60.00				3.00	6.00	0.00				20.00				20.00			0.67	0.10		0.67	0.10	0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5601	023	0		29	10	S5601_023_0	2	Preferred Brand	4	000101	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					27.00	54.00	67.50											47.00	94.00	141.00				27.00	54.00	67.50				47.00				47.00			1.57	0.90		1.57	0.90	1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	023	0		29	10	S5601_023_0	2	Non-Preferred Drug	4	100100	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											82.34	50	50	50				65.87	40	40	40										50	50	50				40	40	40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	023	0		29	10	S5601_023_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		34											377.68	33						377.68	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	024	0		29	10	S5601_024_0	3	Preferred Generic	3	001001	1	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	3.00	6.00	7.50																									3.00	6.00	9.00				3.00	6.00	0.00				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	024	0		29	10	S5601_024_0	3	Generic	3	010001	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	13.00	26.00	32.50																									13.00	26.00	39.00				13.00	26.00	32.50				13.00				13.00		0.43				0.43	0.43	0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	024	0		29	10	S5601_024_0	3	Preferred Brand	3	000101	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	45.00	90.00	112.50																									45.00	90.00	135.00				45.00	90.00	112.50				45.00				45.00		1.50				1.50	1.50	1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	024	0		29	10	S5601_024_0	3	Non-Preferred Drug	3	100100	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34				74.96	50	50	50																								50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	024	0		29	10	S5601_024_0	3	Specialty Tier	3	010010	1	1	5	1	010		01		010	1	30											30			30		34				417.58	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	025	0		29	10	S5601_025_0	2	Preferred Generic	4	001001	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	025	0		29	10	S5601_025_0	2	Preferred Generic	4	001001	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5601	025	0		29	10	S5601_025_0	2	Generic	4	010001	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					3.00	6.00	7.50											20.00	40.00	60.00				3.00	6.00	0.00				20.00				20.00			0.67	0.10		0.67	0.10	0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	025	0		29	10	S5601_025_0	2	Generic	4	010001	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					3.00	6.00	7.50											20.00	40.00	60.00				3.00	6.00	0.00				20.00				20.00			0.67	0.10		0.67	0.10	0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5601	025	0		29	10	S5601_025_0	2	Preferred Brand	4	000101	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					27.00	54.00	67.50											47.00	94.00	141.00				27.00	54.00	67.50				47.00				47.00			1.57	0.90		1.57	0.90	1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	025	0		29	10	S5601_025_0	2	Non-Preferred Drug	4	100100	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											69.99	50	50	50				55.99	40	40	40										50	50	50				40	40	40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	025	0		29	10	S5601_025_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		34											287.73	33						287.73	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	026	0		29	10	S5601_026_0	3	Preferred Generic	3	001001	1	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	3.00	6.00	7.50																									3.00	6.00	9.00				3.00	6.00	7.50				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	026	0		29	10	S5601_026_0	3	Generic	3	010001	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	14.00	28.00	35.00																									14.00	28.00	42.00				14.00	28.00	35.00				14.00				14.00		0.47				0.47	0.47	0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	026	0		29	10	S5601_026_0	3	Preferred Brand	3	000101	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	45.00	90.00	112.50																									45.00	90.00	135.00				45.00	90.00	112.50				45.00				45.00		1.50				1.50	1.50	1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	026	0		29	10	S5601_026_0	3	Non-Preferred Drug	3	100100	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34				89.15	49	49	49																								49	49	49				49	49	49			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	026	0		29	10	S5601_026_0	3	Specialty Tier	3	010010	1	1	5	1	010		01		010	1	30											30			30		34				550.90	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	027	0		29	10	S5601_027_0	2	Preferred Generic	4	001001	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	027	0		29	10	S5601_027_0	2	Preferred Generic	4	001001	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5601	027	0		29	10	S5601_027_0	2	Generic	4	010001	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					3.00	6.00	7.50											20.00	40.00	60.00				3.00	6.00	0.00				20.00				20.00			0.67	0.10		0.67	0.10	0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	027	0		29	10	S5601_027_0	2	Generic	4	010001	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					3.00	6.00	7.50											20.00	40.00	60.00				3.00	6.00	0.00				20.00				20.00			0.67	0.10		0.67	0.10	0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5601	027	0		29	10	S5601_027_0	2	Preferred Brand	4	000101	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					27.00	54.00	67.50											47.00	94.00	141.00				27.00	54.00	67.50				47.00				47.00			1.57	0.90		1.57	0.90	1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	027	0		29	10	S5601_027_0	2	Non-Preferred Drug	4	100100	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											80.30	50	50	50				64.24	40	40	40										50	50	50				40	40	40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	027	0		29	10	S5601_027_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		34											414.16	33						414.16	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	028	0		29	10	S5601_028_0	3	Preferred Generic	3	001001	1	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	3.00	6.00	7.50																									3.00	6.00	9.00				3.00	6.00	0.00				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	028	0		29	10	S5601_028_0	3	Generic	3	010001	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	17.00	34.00	42.50																									17.00	34.00	51.00				17.00	34.00	42.50				17.00				17.00		0.57				0.57	0.57	0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	028	0		29	10	S5601_028_0	3	Preferred Brand	3	000101	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	46.00	92.00	115.00																									46.00	92.00	138.00				46.00	92.00	115.00				46.00				46.00		1.53				1.53	1.53	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	028	0		29	10	S5601_028_0	3	Non-Preferred Drug	3	100100	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34				80.75	49	49	49																								49	49	49				49	49	49			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	028	0		29	10	S5601_028_0	3	Specialty Tier	3	010010	1	1	5	1	010		01		010	1	30											30			30		34				450.64	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	029	0		29	10	S5601_029_0	2	Preferred Generic	4	001001	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	029	0		29	10	S5601_029_0	2	Preferred Generic	4	001001	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5601	029	0		29	10	S5601_029_0	2	Generic	4	010001	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					3.00	6.00	7.50											20.00	40.00	60.00				3.00	6.00	0.00				20.00				20.00			0.67	0.10		0.67	0.10	0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	029	0		29	10	S5601_029_0	2	Generic	4	010001	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					3.00	6.00	7.50											20.00	40.00	60.00				3.00	6.00	0.00				20.00				20.00			0.67	0.10		0.67	0.10	0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5601	029	0		29	10	S5601_029_0	2	Preferred Brand	4	000101	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					27.00	54.00	67.50											47.00	94.00	141.00				27.00	54.00	67.50				47.00				47.00			1.57	0.90		1.57	0.90	1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	029	0		29	10	S5601_029_0	2	Non-Preferred Drug	4	100100	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											74.24	50	50	50				59.40	40	40	40										50	50	50				40	40	40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	029	0		29	10	S5601_029_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		34											395.35	33						395.35	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	030	0		29	10	S5601_030_0	3	Preferred Generic	3	001001	1	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	3.00	6.00	7.50																									3.00	6.00	9.00				3.00	6.00	7.50				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	030	0		29	10	S5601_030_0	3	Generic	3	010001	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	14.00	28.00	35.00																									14.00	28.00	42.00				14.00	28.00	35.00				14.00				14.00		0.47				0.47	0.47	0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	030	0		29	10	S5601_030_0	3	Preferred Brand	3	000101	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	45.00	90.00	112.50																									45.00	90.00	135.00				45.00	90.00	112.50				45.00				45.00		1.50				1.50	1.50	1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	030	0		29	10	S5601_030_0	3	Non-Preferred Drug	3	100100	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34				78.39	50	50	50																								50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	030	0		29	10	S5601_030_0	3	Specialty Tier	3	010010	1	1	5	1	010		01		010	1	30											30			30		34				380.99	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	031	0		29	10	S5601_031_0	2	Preferred Generic	4	001001	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	031	0		29	10	S5601_031_0	2	Preferred Generic	4	001001	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5601	031	0		29	10	S5601_031_0	2	Generic	4	010001	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					3.00	6.00	7.50											20.00	40.00	60.00				3.00	6.00	0.00				20.00				20.00			0.67	0.10		0.67	0.10	0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	031	0		29	10	S5601_031_0	2	Generic	4	010001	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					3.00	6.00	7.50											20.00	40.00	60.00				3.00	6.00	0.00				20.00				20.00			0.67	0.10		0.67	0.10	0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5601	031	0		29	10	S5601_031_0	2	Preferred Brand	4	000101	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					33.00	66.00	82.50											47.00	94.00	141.00				33.00	66.00	82.50				47.00				47.00			1.57	1.10		1.57	1.10	1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	031	0		29	10	S5601_031_0	2	Non-Preferred Drug	4	100100	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											71.98	50	50	50				64.78	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	031	0		29	10	S5601_031_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		34											286.47	33						286.47	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	032	0		29	10	S5601_032_0	3	Preferred Generic	3	001001	1	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	3.00	6.00	7.50																									3.00	6.00	9.00				3.00	6.00	7.50				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	032	0		29	10	S5601_032_0	3	Generic	3	010001	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	12.00	24.00	30.00																									12.00	24.00	36.00				12.00	24.00	30.00				12.00				12.00		0.40				0.40	0.40	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	032	0		29	10	S5601_032_0	3	Preferred Brand	3	000101	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	43.00	86.00	107.50																									43.00	86.00	129.00				43.00	86.00	107.50				43.00				43.00		1.43				1.43	1.43	1.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	032	0		29	10	S5601_032_0	3	Non-Preferred Drug	3	100100	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34				83.81	46	46	46																								46	46	46				46	46	46			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	032	0		29	10	S5601_032_0	3	Specialty Tier	3	010010	1	1	5	1	010		01		010	1	30											30			30		34				512.15	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	033	0		29	10	S5601_033_0	2	Preferred Generic	4	001001	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	033	0		29	10	S5601_033_0	2	Preferred Generic	4	001001	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5601	033	0		29	10	S5601_033_0	2	Generic	4	010001	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					3.00	6.00	7.50											20.00	40.00	60.00				3.00	6.00	0.00				20.00				20.00			0.67	0.10		0.67	0.10	0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	033	0		29	10	S5601_033_0	2	Generic	4	010001	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					3.00	6.00	7.50											20.00	40.00	60.00				3.00	6.00	0.00				20.00				20.00			0.67	0.10		0.67	0.10	0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5601	033	0		29	10	S5601_033_0	2	Preferred Brand	4	000101	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					27.00	54.00	67.50											47.00	94.00	141.00				27.00	54.00	67.50				47.00				47.00			1.57	0.90		1.57	0.90	1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	033	0		29	10	S5601_033_0	2	Non-Preferred Drug	4	100100	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											76.01	50	50	50				60.81	40	40	40										50	50	50				40	40	40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	033	0		29	10	S5601_033_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		34											408.60	33						408.60	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	034	0		29	10	S5601_034_0	3	Preferred Generic	3	001001	1	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	3.00	6.00	7.50																									3.00	6.00	9.00				3.00	6.00	7.50				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	034	0		29	10	S5601_034_0	3	Generic	3	010001	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	18.00	36.00	45.00																									18.00	36.00	54.00				18.00	36.00	45.00				18.00				18.00		0.60				0.60	0.60	0.53	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	034	0		29	10	S5601_034_0	3	Preferred Brand	3	000101	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	46.00	92.00	115.00																									46.00	92.00	138.00				46.00	92.00	115.00				46.00				46.00		1.53				1.53	1.53	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	034	0		29	10	S5601_034_0	3	Non-Preferred Drug	3	100100	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34				80.39	50	50	50																								50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	034	0		29	10	S5601_034_0	3	Specialty Tier	3	010010	1	1	5	1	010		01		010	1	30											30			30		34				429.80	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	035	0		29	10	S5601_035_0	2	Preferred Generic	4	001001	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	035	0		29	10	S5601_035_0	2	Preferred Generic	4	001001	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5601	035	0		29	10	S5601_035_0	2	Generic	4	010001	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					3.00	6.00	7.50											20.00	40.00	60.00				3.00	6.00	0.00				20.00				20.00			0.67	0.10		0.67	0.10	0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	035	0		29	10	S5601_035_0	2	Generic	4	010001	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					3.00	6.00	7.50											20.00	40.00	60.00				3.00	6.00	0.00				20.00				20.00			0.67	0.10		0.67	0.10	0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5601	035	0		29	10	S5601_035_0	2	Preferred Brand	4	000101	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					27.00	54.00	67.50											47.00	94.00	141.00				27.00	54.00	67.50				47.00				47.00			1.57	0.90		1.57	0.90	1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	035	0		29	10	S5601_035_0	2	Non-Preferred Drug	4	100100	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											76.63	50	50	50				61.31	40	40	40										50	50	50				40	40	40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	035	0		29	10	S5601_035_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		34											317.32	33						317.32	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	036	0		29	10	S5601_036_0	3	Preferred Generic	3	001001	1	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	3.00	6.00	7.50																									3.00	6.00	9.00				3.00	6.00	0.00				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	036	0		29	10	S5601_036_0	3	Generic	3	010001	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	12.00	24.00	30.00																									12.00	24.00	36.00				12.00	24.00	30.00				12.00				12.00		0.40				0.40	0.40	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	036	0		29	10	S5601_036_0	3	Preferred Brand	3	000101	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	43.00	86.00	107.50																									43.00	86.00	129.00				43.00	86.00	107.50				43.00				43.00		1.43				1.43	1.43	1.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	036	0		29	10	S5601_036_0	3	Non-Preferred Drug	3	100100	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34				81.06	47	47	47																								47	47	47				47	47	47			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	036	0		29	10	S5601_036_0	3	Specialty Tier	3	010010	1	1	5	1	010		01		010	1	30											30			30		34				413.34	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	037	0		29	10	S5601_037_0	2	Preferred Generic	4	001001	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	037	0		29	10	S5601_037_0	2	Preferred Generic	4	001001	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5601	037	0		29	10	S5601_037_0	2	Generic	4	010001	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					3.00	6.00	7.50											20.00	40.00	60.00				3.00	6.00	0.00				20.00				20.00			0.67	0.10		0.67	0.10	0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	037	0		29	10	S5601_037_0	2	Generic	4	010001	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					3.00	6.00	7.50											20.00	40.00	60.00				3.00	6.00	0.00				20.00				20.00			0.67	0.10		0.67	0.10	0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5601	037	0		29	10	S5601_037_0	2	Preferred Brand	4	000101	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					27.00	54.00	67.50											47.00	94.00	141.00				27.00	54.00	67.50				47.00				47.00			1.57	0.90		1.57	0.90	1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	037	0		29	10	S5601_037_0	2	Non-Preferred Drug	4	100100	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											72.19	50	50	50				57.75	40	40	40										50	50	50				40	40	40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	037	0		29	10	S5601_037_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		34											253.54	33						253.54	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	038	0		29	10	S5601_038_0	3	Preferred Generic	3	001001	1	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	3.00	6.00	7.50																									3.00	6.00	9.00				3.00	6.00	7.50				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	038	0		29	10	S5601_038_0	3	Generic	3	010001	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	13.00	26.00	32.50																									13.00	26.00	39.00				13.00	26.00	32.50				13.00				13.00		0.43				0.43	0.43	0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	038	0		29	10	S5601_038_0	3	Preferred Brand	3	000101	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	46.00	92.00	115.00																									46.00	92.00	138.00				46.00	92.00	115.00				46.00				46.00		1.53				1.53	1.53	1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	038	0		29	10	S5601_038_0	3	Non-Preferred Drug	3	100100	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34				72.44	50	50	50																								50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	038	0		29	10	S5601_038_0	3	Specialty Tier	3	010010	1	1	5	1	010		01		010	1	30											30			30		34				353.82	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	040	0		29	10	S5601_040_0	3	Preferred Generic	3	001001	1	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	3.00	6.00	7.50																									3.00	6.00	9.00				3.00	6.00	7.50				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	040	0		29	10	S5601_040_0	3	Generic	3	010001	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	14.00	28.00	35.00																									14.00	28.00	42.00				14.00	28.00	35.00				14.00				14.00		0.47				0.47	0.47	0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	040	0		29	10	S5601_040_0	3	Preferred Brand	3	000101	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	45.00	90.00	112.50																									45.00	90.00	135.00				45.00	90.00	112.50				45.00				45.00		1.50				1.50	1.50	1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	040	0		29	10	S5601_040_0	3	Non-Preferred Drug	3	100100	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34				74.69	50	50	50																								50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	040	0		29	10	S5601_040_0	3	Specialty Tier	3	010010	1	1	5	1	010		01		010	1	30											30			30		34				355.31	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	041	0		29	10	S5601_041_0	2	Preferred Generic	4	001001	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	041	0		29	10	S5601_041_0	2	Preferred Generic	4	001001	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5601	041	0		29	10	S5601_041_0	2	Generic	4	010001	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					3.00	6.00	7.50											20.00	40.00	60.00				3.00	6.00	0.00				20.00				20.00			0.67	0.10		0.67	0.10	0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	041	0		29	10	S5601_041_0	2	Generic	4	010001	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					3.00	6.00	7.50											20.00	40.00	60.00				3.00	6.00	0.00				20.00				20.00			0.67	0.10		0.67	0.10	0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5601	041	0		29	10	S5601_041_0	2	Preferred Brand	4	000101	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					33.00	66.00	82.50											47.00	94.00	141.00				33.00	66.00	82.50				47.00				47.00			1.57	1.10		1.57	1.10	1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	041	0		29	10	S5601_041_0	2	Non-Preferred Drug	4	100100	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											64.23	50	50	50				57.80	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	041	0		29	10	S5601_041_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		34											262.77	33						262.77	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	042	0		29	10	S5601_042_0	3	Preferred Generic	3	001001	1	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	3.00	6.00	7.50																									3.00	6.00	9.00				3.00	6.00	7.50				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	042	0		29	10	S5601_042_0	3	Generic	3	010001	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	12.00	24.00	30.00																									12.00	24.00	36.00				12.00	24.00	30.00				12.00				12.00		0.40				0.40	0.40	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	042	0		29	10	S5601_042_0	3	Preferred Brand	3	000101	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	43.00	86.00	107.50																									43.00	86.00	129.00				43.00	86.00	107.50				43.00				43.00		1.43				1.43	1.43	1.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	042	0		29	10	S5601_042_0	3	Non-Preferred Drug	3	100100	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34				74.60	47	47	47																								47	47	47				47	47	47			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	042	0		29	10	S5601_042_0	3	Specialty Tier	3	010010	1	1	5	1	010		01		010	1	30											30			30		34				366.18	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	044	0		29	10	S5601_044_0	3	Preferred Generic	3	001001	1	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	3.00	6.00	7.50																									3.00	6.00	9.00				3.00	6.00	7.50				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	044	0		29	10	S5601_044_0	3	Generic	3	010001	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	20.00	40.00	50.00																									20.00	40.00	60.00				20.00	40.00	50.00				20.00				20.00		0.67				0.67	0.67	0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	044	0		29	10	S5601_044_0	3	Preferred Brand	3	000101	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	47.00	94.00	117.50																									47.00	94.00	141.00				47.00	94.00	117.50				47.00				47.00		1.57				1.57	1.57	1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	044	0		29	10	S5601_044_0	3	Non-Preferred Drug	3	100100	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34				84.04	50	50	50																								50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	044	0		29	10	S5601_044_0	3	Specialty Tier	3	010010	1	1	5	1	010		01		010	1	30											30			30		34				491.82	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	045	0		29	10	S5601_045_0	2	Preferred Generic	4	001001	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	045	0		29	10	S5601_045_0	2	Preferred Generic	4	001001	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5601	045	0		29	10	S5601_045_0	2	Generic	4	010001	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					3.00	6.00	7.50											20.00	40.00	60.00				3.00	6.00	0.00				20.00				20.00			0.67	0.10		0.67	0.10	0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	045	0		29	10	S5601_045_0	2	Generic	4	010001	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					3.00	6.00	7.50											20.00	40.00	60.00				3.00	6.00	0.00				20.00				20.00			0.67	0.10		0.67	0.10	0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5601	045	0		29	10	S5601_045_0	2	Preferred Brand	4	000101	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					33.00	66.00	82.50											47.00	94.00	141.00				33.00	66.00	82.50				47.00				47.00			1.57	1.10		1.57	1.10	1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	045	0		29	10	S5601_045_0	2	Non-Preferred Drug	4	100100	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											77.49	50	50	50				69.74	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	045	0		29	10	S5601_045_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		34											339.16	33						339.16	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	046	0		29	10	S5601_046_0	3	Preferred Generic	3	001001	1	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	3.00	6.00	7.50																									3.00	6.00	9.00				3.00	6.00	7.50				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	046	0		29	10	S5601_046_0	3	Generic	3	010001	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	12.00	24.00	30.00																									12.00	24.00	36.00				12.00	24.00	30.00				12.00				12.00		0.40				0.40	0.40	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	046	0		29	10	S5601_046_0	3	Preferred Brand	3	000101	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	43.00	86.00	107.50																									43.00	86.00	129.00				43.00	86.00	107.50				43.00				43.00		1.43				1.43	1.43	1.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	046	0		29	10	S5601_046_0	3	Non-Preferred Drug	3	100100	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34				80.26	49	49	49																								49	49	49				49	49	49			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	046	0		29	10	S5601_046_0	3	Specialty Tier	3	010010	1	1	5	1	010		01		010	1	30											30			30		34				463.60	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	048	0		29	10	S5601_048_0	3	Preferred Generic	3	001001	1	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	3.00	6.00	7.50																									3.00	6.00	9.00				3.00	6.00	7.50				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	048	0		29	10	S5601_048_0	3	Generic	3	010001	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	14.00	28.00	35.00																									14.00	28.00	42.00				14.00	28.00	35.00				14.00				14.00		0.47				0.47	0.47	0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	048	0		29	10	S5601_048_0	3	Preferred Brand	3	000101	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	45.00	90.00	112.50																									45.00	90.00	135.00				45.00	90.00	112.50				45.00				45.00		1.50				1.50	1.50	1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	048	0		29	10	S5601_048_0	3	Non-Preferred Drug	3	100100	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34				78.98	50	50	50																								50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	048	0		29	10	S5601_048_0	3	Specialty Tier	3	010010	1	1	5	1	010		01		010	1	30											30			30		34				358.26	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	049	0		29	10	S5601_049_0	2	Preferred Generic	4	001001	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	049	0		29	10	S5601_049_0	2	Preferred Generic	4	001001	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5601	049	0		29	10	S5601_049_0	2	Generic	4	010001	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					3.00	6.00	7.50											20.00	40.00	60.00				3.00	6.00	0.00				20.00				20.00			0.67	0.10		0.67	0.10	0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	049	0		29	10	S5601_049_0	2	Generic	4	010001	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					3.00	6.00	7.50											20.00	40.00	60.00				3.00	6.00	0.00				20.00				20.00			0.67	0.10		0.67	0.10	0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5601	049	0		29	10	S5601_049_0	2	Preferred Brand	4	000101	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					27.00	54.00	67.50											47.00	94.00	141.00				27.00	54.00	67.50				47.00				47.00			1.57	0.90		1.57	0.90	1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	049	0		29	10	S5601_049_0	2	Non-Preferred Drug	4	100100	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											72.37	50	50	50				57.89	40	40	40										50	50	50				40	40	40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	049	0		29	10	S5601_049_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		34											240.29	33						240.29	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	050	0		29	10	S5601_050_0	3	Preferred Generic	3	001001	1	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	3.00	6.00	7.50																									3.00	6.00	9.00				3.00	6.00	7.50				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	050	0		29	10	S5601_050_0	3	Generic	3	010001	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	14.00	28.00	35.00																									14.00	28.00	42.00				14.00	28.00	35.00				14.00				14.00		0.47				0.47	0.47	0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	050	0		29	10	S5601_050_0	3	Preferred Brand	3	000101	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	42.00	84.00	105.00																									42.00	84.00	126.00				42.00	84.00	105.00				42.00				42.00		1.40				1.40	1.40	1.24	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	050	0		29	10	S5601_050_0	3	Non-Preferred Drug	3	100100	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34				81.60	48	48	48																								48	48	48				48	48	48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	050	0		29	10	S5601_050_0	3	Specialty Tier	3	010010	1	1	5	1	010		01		010	1	30											30			30		34				458.44	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	051	0		29	10	S5601_051_0	2	Preferred Generic	4	001001	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	051	0		29	10	S5601_051_0	2	Preferred Generic	4	001001	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5601	051	0		29	10	S5601_051_0	2	Generic	4	010001	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					3.00	6.00	7.50											20.00	40.00	60.00				3.00	6.00	0.00				20.00				20.00			0.67	0.10		0.67	0.10	0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	051	0		29	10	S5601_051_0	2	Generic	4	010001	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					3.00	6.00	7.50											20.00	40.00	60.00				3.00	6.00	0.00				20.00				20.00			0.67	0.10		0.67	0.10	0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5601	051	0		29	10	S5601_051_0	2	Preferred Brand	4	000101	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					27.00	54.00	67.50											47.00	94.00	141.00				27.00	54.00	67.50				47.00				47.00			1.57	0.90		1.57	0.90	1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	051	0		29	10	S5601_051_0	2	Non-Preferred Drug	4	100100	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											74.26	50	50	50				59.41	40	40	40										50	50	50				40	40	40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	051	0		29	10	S5601_051_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		34											291.46	33						291.46	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	052	0		29	10	S5601_052_0	3	Preferred Generic	3	001001	1	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	3.00	6.00	7.50																									3.00	6.00	9.00				3.00	6.00	7.50				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	052	0		29	10	S5601_052_0	3	Generic	3	010001	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	15.00	30.00	37.50																									15.00	30.00	45.00				15.00	30.00	37.50				15.00				15.00		0.50				0.50	0.50	0.44	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	052	0		29	10	S5601_052_0	3	Preferred Brand	3	000101	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	47.00	94.00	117.50																									47.00	94.00	141.00				47.00	94.00	117.50				47.00				47.00		1.57				1.57	1.57	1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	052	0		29	10	S5601_052_0	3	Non-Preferred Drug	3	100100	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34				79.82	50	50	50																								50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	052	0		29	10	S5601_052_0	3	Specialty Tier	3	010010	1	1	5	1	010		01		010	1	30											30			30		34				665.82	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	053	0		29	10	S5601_053_0	2	Preferred Generic	4	001001	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	053	0		29	10	S5601_053_0	2	Preferred Generic	4	001001	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5601	053	0		29	10	S5601_053_0	2	Generic	4	010001	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					3.00	6.00	7.50											20.00	40.00	60.00				3.00	6.00	0.00				20.00				20.00			0.67	0.10		0.67	0.10	0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	053	0		29	10	S5601_053_0	2	Generic	4	010001	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					3.00	6.00	7.50											20.00	40.00	60.00				3.00	6.00	0.00				20.00				20.00			0.67	0.10		0.67	0.10	0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5601	053	0		29	10	S5601_053_0	2	Preferred Brand	4	000101	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					27.00	54.00	67.50											47.00	94.00	141.00				27.00	54.00	67.50				47.00				47.00			1.57	0.90		1.57	0.90	1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	053	0		29	10	S5601_053_0	2	Non-Preferred Drug	4	100100	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											69.03	50	50	50				55.23	40	40	40										50	50	50				40	40	40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	053	0		29	10	S5601_053_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		34											275.40	33						275.40	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	054	0		29	10	S5601_054_0	3	Preferred Generic	3	001001	1	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	3.00	6.00	7.50																									3.00	6.00	9.00				3.00	6.00	7.50				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	054	0		29	10	S5601_054_0	3	Generic	3	010001	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	20.00	40.00	50.00																									20.00	40.00	60.00				20.00	40.00	50.00				20.00				20.00		0.67				0.67	0.67	0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	054	0		29	10	S5601_054_0	3	Preferred Brand	3	000101	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	47.00	94.00	117.50																									47.00	94.00	141.00				47.00	94.00	117.50				47.00				47.00		1.57				1.57	1.57	1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	054	0		29	10	S5601_054_0	3	Non-Preferred Drug	3	100100	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34				81.24	50	50	50																								50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	054	0		29	10	S5601_054_0	3	Specialty Tier	3	010010	1	1	5	1	010		01		010	1	30											30			30		34				567.02	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	055	0		29	10	S5601_055_0	2	Preferred Generic	4	001001	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	055	0		29	10	S5601_055_0	2	Preferred Generic	4	001001	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5601	055	0		29	10	S5601_055_0	2	Generic	4	010001	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					3.00	6.00	7.50											20.00	40.00	60.00				3.00	6.00	0.00				20.00				20.00			0.67	0.10		0.67	0.10	0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	055	0		29	10	S5601_055_0	2	Generic	4	010001	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					3.00	6.00	7.50											20.00	40.00	60.00				3.00	6.00	0.00				20.00				20.00			0.67	0.10		0.67	0.10	0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5601	055	0		29	10	S5601_055_0	2	Preferred Brand	4	000101	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					27.00	54.00	67.50											47.00	94.00	141.00				27.00	54.00	67.50				47.00				47.00			1.57	0.90		1.57	0.90	1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	055	0		29	10	S5601_055_0	2	Non-Preferred Drug	4	100100	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											80.32	50	50	50				64.25	40	40	40										50	50	50				40	40	40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	055	0		29	10	S5601_055_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		34											372.94	33						372.94	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	056	0		29	10	S5601_056_0	3	Preferred Generic	3	001001	1	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	7.00	14.00	21.00																									7.00	14.00	21.00				7.00	14.00	17.50				7.00				7.00		0.23				0.23	0.23	0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	056	0		29	10	S5601_056_0	3	Generic	3	010001	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	40.00	50.00				20.00				20.00		0.67				0.67	0.67	0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	056	0		29	10	S5601_056_0	3	Preferred Brand	3	000101	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	94.00	117.50				47.00				47.00		1.57				1.57	1.57	1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	056	0		29	10	S5601_056_0	3	Non-Preferred Drug	3	100100	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34				84.03	50	50	50																								50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	056	0		29	10	S5601_056_0	3	Specialty Tier	3	010010	1	1	5	1	010		01		010	1	30											30			30		34				574.60	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	057	0		29	10	S5601_057_0	2	Preferred Generic	4	001001	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	057	0		29	10	S5601_057_0	2	Preferred Generic	4	001001	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5601	057	0		29	10	S5601_057_0	2	Generic	4	010001	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					3.00	6.00	7.50											20.00	40.00	60.00				3.00	6.00	0.00				20.00				20.00			0.67	0.10		0.67	0.10	0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	057	0		29	10	S5601_057_0	2	Generic	4	010001	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					3.00	6.00	7.50											20.00	40.00	60.00				3.00	6.00	0.00				20.00				20.00			0.67	0.10		0.67	0.10	0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5601	057	0		29	10	S5601_057_0	2	Preferred Brand	4	000101	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					27.00	54.00	67.50											47.00	94.00	141.00				27.00	54.00	67.50				47.00				47.00			1.57	0.90		1.57	0.90	1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	057	0		29	10	S5601_057_0	2	Non-Preferred Drug	4	100100	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											79.85	50	50	50				63.88	40	40	40										50	50	50				40	40	40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	057	0		29	10	S5601_057_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		34											383.41	33						383.41	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	058	0		29	10	S5601_058_0	3	Preferred Generic	3	001001	1	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	7.00	14.00	17.50																									7.00	14.00	21.00				7.00	14.00	17.50				7.00				7.00		0.23				0.23	0.23	0.21	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	058	0		29	10	S5601_058_0	3	Generic	3	010001	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	20.00	40.00	50.00																									20.00	40.00	60.00				20.00	40.00	50.00				20.00				20.00		0.67				0.67	0.67	0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	058	0		29	10	S5601_058_0	3	Preferred Brand	3	000101	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	47.00	94.00	117.50																									47.00	94.00	141.00				47.00	94.00	117.50				47.00				47.00		1.57				1.57	1.57	1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	058	0		29	10	S5601_058_0	3	Non-Preferred Drug	3	100100	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34				85.14	50	50	50																								50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	058	0		29	10	S5601_058_0	3	Specialty Tier	3	010010	1	1	5	1	010		01		010	1	30											30			30		34				534.82	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	059	0		29	10	S5601_059_0	2	Preferred Generic	4	001001	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	059	0		29	10	S5601_059_0	2	Preferred Generic	4	001001	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5601	059	0		29	10	S5601_059_0	2	Generic	4	010001	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					3.00	6.00	7.50											20.00	40.00	60.00				3.00	6.00	0.00				20.00				20.00			0.67	0.10		0.67	0.10	0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	059	0		29	10	S5601_059_0	2	Generic	4	010001	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					3.00	6.00	7.50											20.00	40.00	60.00				3.00	6.00	0.00				20.00				20.00			0.67	0.10		0.67	0.10	0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5601	059	0		29	10	S5601_059_0	2	Preferred Brand	4	000101	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					27.00	54.00	67.50											47.00	94.00	141.00				27.00	54.00	67.50				47.00				47.00			1.57	0.90		1.57	0.90	1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	059	0		29	10	S5601_059_0	2	Non-Preferred Drug	4	100100	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											79.63	50	50	50				63.71	40	40	40										50	50	50				40	40	40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	059	0		29	10	S5601_059_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		34											436.76	33						436.76	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	060	0		29	10	S5601_060_0	3	Preferred Generic	3	001001	1	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	3.00	6.00	7.50																									3.00	6.00	9.00				3.00	6.00	7.50				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	060	0		29	10	S5601_060_0	3	Generic	3	010001	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	12.00	24.00	30.00																									12.00	24.00	36.00				12.00	24.00	30.00				12.00				12.00		0.40				0.40	0.40	0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	060	0		29	10	S5601_060_0	3	Preferred Brand	3	000101	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	44.00	88.00	110.00																									44.00	88.00	132.00				44.00	88.00	110.00				44.00				44.00		1.47				1.47	1.47	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	060	0		29	10	S5601_060_0	3	Non-Preferred Drug	3	100100	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34				79.92	48	48	48																								48	48	48				48	48	48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	060	0		29	10	S5601_060_0	3	Specialty Tier	3	010010	1	1	5	1	010		01		010	1	30											30			30		34				639.24	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	061	0		29	10	S5601_061_0	2	Preferred Generic	4	001001	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	061	0		29	10	S5601_061_0	2	Preferred Generic	4	001001	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5601	061	0		29	10	S5601_061_0	2	Generic	4	010001	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					3.00	6.00	7.50											20.00	40.00	60.00				3.00	6.00	0.00				20.00				20.00			0.67	0.10		0.67	0.10	0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	061	0		29	10	S5601_061_0	2	Generic	4	010001	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					3.00	6.00	7.50											20.00	40.00	60.00				3.00	6.00	0.00				20.00				20.00			0.67	0.10		0.67	0.10	0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5601	061	0		29	10	S5601_061_0	2	Preferred Brand	4	000101	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					27.00	54.00	67.50											47.00	94.00	141.00				27.00	54.00	67.50				47.00				47.00			1.57	0.90		1.57	0.90	1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	061	0		29	10	S5601_061_0	2	Non-Preferred Drug	4	100100	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											78.74	50	50	50				62.99	40	40	40										50	50	50				40	40	40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	061	0		29	10	S5601_061_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		34											429.69	33						429.69	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	062	0		29	10	S5601_062_0	3	Preferred Generic	3	001001	1	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	3.00	6.00	7.50																									3.00	6.00	9.00				3.00	6.00	7.50				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	062	0		29	10	S5601_062_0	3	Generic	3	010001	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	14.00	28.00	35.00																									14.00	28.00	42.00				14.00	28.00	35.00				14.00				14.00		0.47				0.47	0.47	0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	062	0		29	10	S5601_062_0	3	Preferred Brand	3	000101	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	45.00	90.00	112.50																									45.00	90.00	135.00				45.00	90.00	112.50				45.00				45.00		1.50				1.50	1.50	1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	062	0		29	10	S5601_062_0	3	Non-Preferred Drug	3	100100	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34				84.95	50	50	50																								50	50	50				50	50	50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	062	0		29	10	S5601_062_0	3	Specialty Tier	3	010010	1	1	5	1	010		01		010	1	30											30			30		34				625.16	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	063	0		29	10	S5601_063_0	2	Preferred Generic	4	001001	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	063	0		29	10	S5601_063_0	2	Preferred Generic	4	001001	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5601	063	0		29	10	S5601_063_0	2	Generic	4	010001	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					3.00	6.00	7.50											20.00	40.00	60.00				3.00	6.00	0.00				20.00				20.00			0.67	0.10		0.67	0.10	0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	063	0		29	10	S5601_063_0	2	Generic	4	010001	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					3.00	6.00	7.50											20.00	40.00	60.00				3.00	6.00	0.00				20.00				20.00			0.67	0.10		0.67	0.10	0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5601	063	0		29	10	S5601_063_0	2	Preferred Brand	4	000101	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					27.00	54.00	67.50											47.00	94.00	141.00				27.00	54.00	67.50				47.00				47.00			1.57	0.90		1.57	0.90	1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	063	0		29	10	S5601_063_0	2	Non-Preferred Drug	4	100100	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											71.26	50	50	50				57.00	40	40	40										50	50	50				40	40	40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	063	0		29	10	S5601_063_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		34											370.93	33						370.93	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	064	0		29	10	S5601_064_0	3	Preferred Generic	3	001001	1	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	3.00	6.00	7.50																									3.00	6.00	9.00				3.00	6.00	7.50				3.00				3.00		0.10				0.10	0.10	0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	064	0		29	10	S5601_064_0	3	Generic	3	010001	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	17.00	34.00	42.50																									17.00	34.00	51.00				17.00	34.00	42.50				17.00				17.00		0.57				0.57	0.57	0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	064	0		29	10	S5601_064_0	3	Preferred Brand	3	000101	1	2	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	47.00	94.00	117.50																									47.00	94.00	141.00				47.00	94.00	117.50				47.00				47.00		1.57				1.57	1.57	1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	064	0		29	10	S5601_064_0	3	Non-Preferred Drug	3	100100	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34				87.96	48	48	48																								48	48	48				48	48	48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	064	0		29	10	S5601_064_0	3	Specialty Tier	3	010010	1	1	5	1	010		01		010	1	30											30			30		34				491.45	33																										33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	065	0		29	10	S5601_065_0	2	Preferred Generic	4	001001	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	065	0		29	10	S5601_065_0	2	Preferred Generic	4	001001	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5601	065	0		29	10	S5601_065_0	2	Generic	4	010001	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					3.00	6.00	7.50											20.00	40.00	60.00				3.00	6.00	0.00				20.00				20.00			0.67	0.10		0.67	0.10	0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	065	0		29	10	S5601_065_0	2	Generic	4	010001	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					3.00	6.00	7.50											20.00	40.00	60.00				3.00	6.00	0.00				20.00				20.00			0.67	0.10		0.67	0.10	0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5601	065	0		29	10	S5601_065_0	2	Preferred Brand	4	000101	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					27.00	54.00	67.50											47.00	94.00	141.00				27.00	54.00	67.50				47.00				47.00			1.57	0.90		1.57	0.90	1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	065	0		29	10	S5601_065_0	2	Non-Preferred Drug	4	100100	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											84.98	50	50	50				67.99	40	40	40										50	50	50				40	40	40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	065	0		29	10	S5601_065_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		34											391.33	33						391.33	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	066	0		29	10	S5601_066_0	3	Preferred Generic	2	001001	1	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	1.00	2.00	2.50																									1.00	2.00	3.00				1.00	2.00	2.50				1.00				1.00		0.03				0.03	0.03	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	066	0		29	10	S5601_066_0	3	Generic	2	010001	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	4.00	8.00	10.00																									4.00	8.00	12.00				4.00	8.00	10.00				4.00				4.00		0.13				0.13	0.13	0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	066	0		29	10	S5601_066_0	3	Preferred Brand	2	000101	1	1	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34				30.03	17	17	17																								17	17	17				17	17	17			17			17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	066	0		29	10	S5601_066_0	3	Non-Preferred Drug	2	100100	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34				76.82	36	36	36																								36	36	36				36	36	36			36			36								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	066	0		29	10	S5601_066_0	3	Specialty Tier	2	010010	1	1	5	1	010		01		010	1	30											30			30		34				599.01	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	067	0		29	10	S5601_067_0	2	Preferred Generic	4	001001	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	067	0		29	10	S5601_067_0	2	Preferred Generic	4	001001	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5601	067	0		29	10	S5601_067_0	2	Generic	4	010001	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					3.00	6.00	7.50											20.00	40.00	60.00				3.00	6.00	0.00				20.00				20.00			0.67	0.10		0.67	0.10	0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	067	0		29	10	S5601_067_0	2	Generic	4	010001	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					3.00	6.00	7.50											20.00	40.00	60.00				3.00	6.00	0.00				20.00				20.00			0.67	0.10		0.67	0.10	0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5601	067	0		29	10	S5601_067_0	2	Preferred Brand	4	000101	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					23.00	46.00	57.50											47.00	94.00	141.00				23.00	46.00	57.50				47.00				47.00			1.57	0.77		1.57	0.77	1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	067	0		29	10	S5601_067_0	2	Non-Preferred Drug	4	100100	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											80.18	50	50	50				62.54	39	39	39										50	50	50				39	39	39			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	067	0		29	10	S5601_067_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		34											380.51	33						380.51	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	068	0		29	10	S5601_068_0	3	Preferred Generic	2	001001	1	2	1	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	1.00	2.00	2.50																									1.00	2.00	3.00				1.00	2.00	2.50				1.00				1.00		0.03				0.03	0.03	0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	068	0		29	10	S5601_068_0	3	Generic	2	010001	1	2	2	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34	4.00	8.00	10.00																									4.00	8.00	12.00				4.00	8.00	10.00				4.00				4.00		0.13				0.13	0.13	0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	068	0		29	10	S5601_068_0	3	Preferred Brand	2	000101	1	1	3	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34				10.85	15	15	15																								15	15	15				15	15	15			15			15								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	068	0		29	10	S5601_068_0	3	Non-Preferred Drug	2	100100	1	1	4	1	111		01		111	1	30	60	90				1	2				30	60	90	30		34				49.16	35	35	35																								35	35	35				35	35	35			35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	068	0		29	10	S5601_068_0	3	Specialty Tier	2	010010	1	1	5	1	010		01		010	1	30											30			30		34				433.95	25																										25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	107	0		29	10	S5601_107_0	2	Preferred Generic	4	001001	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	107	0		29	10	S5601_107_0	2	Preferred Generic	4	001001	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5601	107	0		29	10	S5601_107_0	2	Generic	4	010001	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					3.00	6.00	7.50											20.00	40.00	60.00				3.00	6.00	0.00				20.00				20.00			0.67	0.10		0.67	0.10	0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	107	0		29	10	S5601_107_0	2	Generic	4	010001	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					3.00	6.00	7.50											20.00	40.00	60.00				3.00	6.00	0.00				20.00				20.00			0.67	0.10		0.67	0.10	0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5601	107	0		29	10	S5601_107_0	2	Preferred Brand	4	000101	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					27.00	54.00	67.50											47.00	94.00	141.00				27.00	54.00	67.50				47.00				47.00			1.57	0.90		1.57	0.90	1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	107	0		29	10	S5601_107_0	2	Non-Preferred Drug	4	100100	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											66.07	50	50	50				52.86	40	40	40										50	50	50				40	40	40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	107	0		29	10	S5601_107_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		34											288.73	33						288.73	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	108	0		29	10	S5601_108_0	2	Preferred Generic	4	001001	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	108	0		29	10	S5601_108_0	2	Preferred Generic	4	001001	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5601	108	0		29	10	S5601_108_0	2	Generic	4	010001	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					3.00	6.00	7.50											20.00	40.00	60.00				3.00	6.00	0.00				20.00				20.00			0.67	0.10		0.67	0.10	0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	108	0		29	10	S5601_108_0	2	Generic	4	010001	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					3.00	6.00	7.50											20.00	40.00	60.00				3.00	6.00	0.00				20.00				20.00			0.67	0.10		0.67	0.10	0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5601	108	0		29	10	S5601_108_0	2	Preferred Brand	4	000101	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					27.00	54.00	67.50											47.00	94.00	141.00				27.00	54.00	67.50				47.00				47.00			1.57	0.90		1.57	0.90	1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	108	0		29	10	S5601_108_0	2	Non-Preferred Drug	4	100100	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											70.35	50	50	50				56.28	40	40	40										50	50	50				40	40	40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	108	0		29	10	S5601_108_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		34											315.20	33						315.20	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	109	0		29	10	S5601_109_0	2	Preferred Generic	4	001001	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	109	0		29	10	S5601_109_0	2	Preferred Generic	4	001001	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								10.00	20.00	30.00					0.00	0.00	0.00											10.00	20.00	30.00				0.00	0.00	0.00				10.00				10.00			0.33	0.00		0.33	0.00	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5601	109	0		29	10	S5601_109_0	2	Generic	4	010001	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					3.00	6.00	7.50											20.00	40.00	60.00				3.00	6.00	0.00				20.00				20.00			0.67	0.10		0.67	0.10	0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	109	0		29	10	S5601_109_0	2	Generic	4	010001	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		34								20.00	40.00	60.00					3.00	6.00	7.50											20.00	40.00	60.00				3.00	6.00	0.00				20.00				20.00			0.67	0.10		0.67	0.10	0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5601	109	0		29	10	S5601_109_0	2	Preferred Brand	4	000101	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34								47.00	94.00	141.00					27.00	54.00	67.50											47.00	94.00	141.00				27.00	54.00	67.50				47.00				47.00			1.57	0.90		1.57	0.90	1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	109	0		29	10	S5601_109_0	2	Non-Preferred Drug	4	100100	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		34											73.97	50	50	50				59.18	40	40	40										50	50	50				40	40	40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5601	109	0		29	10	S5601_109_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		34											266.97	33						266.97	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5609	001	0		29	10	S5609_001_0	4	Preferred Generic	3	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	10.00																			5.00	10.00	10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5609	001	0		29	10	S5609_001_0	4	Generic	3	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	30.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5609	001	0		29	10	S5609_001_0	4	Preferred Brand	3	000001	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, Select Care Drugs												
S5609	001	0		29	10	S5609_001_0	4	Non-Preferred Drug	3	100100	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				85.50	45	45	45																		45	45	45															45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5609	001	0		29	10	S5609_001_0	4	Specialty Tier	3	010010	1	1	5	1	010		01	010		1	30								30						30		31				1044.40	28																				28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5609	001	0		29	10	S5609_001_0	4	Select Care Drugs	3	010000	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5609	002	0		29	10	S5609_002_0	6	Preferred Generic	4	001000	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	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5609	002	0		29	10	S5609_002_0	6	Preferred Generic	4	001000	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	4.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5609	002	0		29	10	S5609_002_0	6	Generic	4	010000	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	10.00	10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5609	002	0		29	10	S5609_002_0	6	Preferred Brand	4	000001	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	42.00	84.00	105.00																			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, Select Care Drugs												
S5609	002	0		29	10	S5609_002_0	6	Non-Preferred Drug	4	100100	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				76.00	40	40	40																		40	40	40															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5609	002	0		29	10	S5609_002_0	6	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31				1230.90	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5609	002	0		29	10	S5609_002_0	6	Select Care Drugs	4	010000	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5609	002	0		29	10	S5609_002_0	6	Select Care Drugs	4	010000	1	2	6	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5617	003	0		29	10	S5617_003_0	4	Preferred Generic	2	001000	1	2	1	1		111	01		110	1				30	60	90	1	2				30		90	30		31								9.00	18.00	27.00					2.00	4.00	6.00											9.00		27.00				2.00		6.00				9.00				9.00			0.30	0.07		0.30	0.07	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	003	0		29	10	S5617_003_0	4	Generic	2	010000	1	2	2	1		111	01		110	1				30	60	90	1	2				30		90	30		31								14.00	28.00	42.00					7.00	14.00	21.00											14.00		42.00				7.00		21.00				14.00				14.00			0.47	0.23		0.47	0.23	0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	003	0		29	10	S5617_003_0	4	Preferred Brand	2	000101	1	2	3	1		111	01		110	1				30	60	90	1	2				30		90	30		31								45.00	90.00	135.00					40.00	80.00	120.00											45.00		135.00				40.00		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												
S5617	003	0		29	10	S5617_003_0	4	Non-Preferred Drug	2	100100	1	1	4	1		111	01		110	1				30	60	90	1	2				30		90	30		31											99.55	46	46	46				77.50	46	46	46										46		46				46		46			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	003	0		29	10	S5617_003_0	4	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	008	0		29	10	S5617_008_0	2	Preferred Generic	2	001000	1	2	1	1		111	01		110	1				30	60	90	1	2				30		90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											7.00		21.00				2.00		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												
S5617	008	0		29	10	S5617_008_0	2	Generic	2	010000	1	2	2	1		111	01		110	1				30	60	90	1	2				30		90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00		36.00				7.00		21.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	008	0		29	10	S5617_008_0	2	Preferred Brand	2	000101	1	2	3	1		111	01		110	1				30	60	90	1	2				30		90	30		31								45.00	90.00	135.00					40.00	80.00	120.00											45.00		135.00				40.00		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												
S5617	008	0		29	10	S5617_008_0	2	Non-Preferred Drug	2	100100	1	1	4	1		111	01		110	1				30	60	90	1	2				30		90	30		31											77.30	40	40	40				62.59	40	40	40										40		40				40		40			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	008	0		29	10	S5617_008_0	2	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	013	0		29	10	S5617_013_0	2	Preferred Generic	2	001000	1	2	1	1		111	01		110	1				30	60	90	1	2				30		90	30		31								9.00	18.00	27.00					2.00	4.00	6.00											9.00		27.00				2.00		6.00				9.00				9.00			0.30	0.07		0.30	0.07	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	013	0		29	10	S5617_013_0	2	Generic	2	010000	1	2	2	1		111	01		110	1				30	60	90	1	2				30		90	30		31								14.00	28.00	42.00					7.00	14.00	21.00											14.00		42.00				7.00		21.00				14.00				14.00			0.47	0.23		0.47	0.23	0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	013	0		29	10	S5617_013_0	2	Preferred Brand	2	000101	1	2	3	1		111	01		110	1				30	60	90	1	2				30		90	30		31								45.00	90.00	135.00					40.00	80.00	120.00											45.00		135.00				40.00		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												
S5617	013	0		29	10	S5617_013_0	2	Non-Preferred Drug	2	100100	1	1	4	1		111	01		110	1				30	60	90	1	2				30		90	30		31											95.54	49	49	49				79.45	46	46	46										49		49				46		46			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	013	0		29	10	S5617_013_0	2	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	018	0		29	10	S5617_018_0	2	Preferred Generic	2	001000	1	2	1	1		111	01		110	1				30	60	90	1	2				30		90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											7.00		21.00				2.00		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												
S5617	018	0		29	10	S5617_018_0	2	Generic	2	010000	1	2	2	1		111	01		110	1				30	60	90	1	2				30		90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00		36.00				7.00		21.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	018	0		29	10	S5617_018_0	2	Preferred Brand	2	000101	1	2	3	1		111	01		110	1				30	60	90	1	2				30		90	30		31								45.00	90.00	135.00					40.00	80.00	120.00											45.00		135.00				40.00		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												
S5617	018	0		29	10	S5617_018_0	2	Non-Preferred Drug	2	100100	1	1	4	1		111	01		110	1				30	60	90	1	2				30		90	30		31											83.29	39	39	39				71.20	38	38	38										39		39				38		38			39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	018	0		29	10	S5617_018_0	2	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	053	0		29	10	S5617_053_0	2	Preferred Generic	2	001000	1	2	1	1		111	01		110	1				30	60	90	1	2				30		90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00		18.00				1.00		3.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	053	0		29	10	S5617_053_0	2	Generic	2	010000	1	2	2	1		111	01		110	1				30	60	90	1	2				30		90	30		31								11.00	22.00	33.00					5.00	10.00	15.00											11.00		33.00				5.00		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												
S5617	053	0		29	10	S5617_053_0	2	Preferred Brand	2	000101	1	2	3	1		111	01		110	1				30	60	90	1	2				30		90	30		31								45.00	90.00	135.00					40.00	80.00	120.00											45.00		135.00				40.00		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												
S5617	053	0		29	10	S5617_053_0	2	Non-Preferred Drug	2	100100	1	1	4	1		111	01		110	1				30	60	90	1	2				30		90	30		31											62.81	39	39	39				55.84	38	38	38										39		39				38		38			39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	053	0		29	10	S5617_053_0	2	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	068	0		29	10	S5617_068_0	2	Preferred Generic	2	001000	1	2	1	1		111	01		110	1				30	60	90	1	2				30		90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00		18.00				1.00		3.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	068	0		29	10	S5617_068_0	2	Generic	2	010000	1	2	2	1		111	01		110	1				30	60	90	1	2				30		90	30		31								11.00	22.00	33.00					5.00	10.00	15.00											11.00		33.00				5.00		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												
S5617	068	0		29	10	S5617_068_0	2	Preferred Brand	2	000101	1	2	3	1		111	01		110	1				30	60	90	1	2				30		90	30		31								45.00	90.00	135.00					40.00	80.00	120.00											45.00		135.00				40.00		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												
S5617	068	0		29	10	S5617_068_0	2	Non-Preferred Drug	2	100100	1	1	4	1		111	01		110	1				30	60	90	1	2				30		90	30		31											98.17	48	48	48				79.07	48	48	48										48		48				48		48			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	068	0		29	10	S5617_068_0	2	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	088	0		29	10	S5617_088_0	2	Preferred Generic	2	001000	1	2	1	1		111	01		110	1				30	60	90	1	2				30		90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00		18.00				1.00		3.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	088	0		29	10	S5617_088_0	2	Generic	2	010000	1	2	2	1		111	01		110	1				30	60	90	1	2				30		90	30		31								11.00	22.00	33.00					5.00	10.00	15.00											11.00		33.00				5.00		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												
S5617	088	0		29	10	S5617_088_0	2	Preferred Brand	2	000101	1	2	3	1		111	01		110	1				30	60	90	1	2				30		90	30		31								45.00	90.00	135.00					40.00	80.00	120.00											45.00		135.00				40.00		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												
S5617	088	0		29	10	S5617_088_0	2	Non-Preferred Drug	2	100100	1	1	4	1		111	01		110	1				30	60	90	1	2				30		90	30		31											86.16	43	43	43				76.38	42	42	42										43		43				42		42			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	088	0		29	10	S5617_088_0	2	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	103	0		29	10	S5617_103_0	2	Preferred Generic	2	001000	1	2	1	1		111	01		110	1				30	60	90	1	2				30		90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											7.00		21.00				2.00		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												
S5617	103	0		29	10	S5617_103_0	2	Generic	2	010000	1	2	2	1		111	01		110	1				30	60	90	1	2				30		90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00		36.00				7.00		21.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	103	0		29	10	S5617_103_0	2	Preferred Brand	2	000101	1	2	3	1		111	01		110	1				30	60	90	1	2				30		90	30		31								45.00	90.00	135.00					40.00	80.00	120.00											45.00		135.00				40.00		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												
S5617	103	0		29	10	S5617_103_0	2	Non-Preferred Drug	2	100100	1	1	4	1		111	01		110	1				30	60	90	1	2				30		90	30		31											68.28	39	39	39				60.90	39	39	39										39		39				39		39			39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	103	0		29	10	S5617_103_0	2	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	108	0		29	10	S5617_108_0	2	Preferred Generic	2	001000	1	2	1	1		111	01		110	1				30	60	90	1	2				30		90	30		31								9.00	18.00	27.00					4.00	8.00	12.00											9.00		27.00				4.00		12.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	108	0		29	10	S5617_108_0	2	Generic	2	010000	1	2	2	1		111	01		110	1				30	60	90	1	2				30		90	30		31								14.00	28.00	42.00					9.00	18.00	27.00											14.00		42.00				9.00		27.00				14.00				14.00			0.47	0.30		0.47	0.30	0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	108	0		29	10	S5617_108_0	2	Preferred Brand	2	000101	1	2	3	1		111	01		110	1				30	60	90	1	2				30		90	30		31								45.00	90.00	135.00					40.00	80.00	120.00											45.00		135.00				40.00		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												
S5617	108	0		29	10	S5617_108_0	2	Non-Preferred Drug	2	100100	1	1	4	1		111	01		110	1				30	60	90	1	2				30		90	30		31											94.40	45	45	45				75.12	43	43	43										45		45				43		43			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	108	0		29	10	S5617_108_0	2	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	113	0		29	10	S5617_113_0	2	Preferred Generic	2	001000	1	2	1	1		111	01		110	1				30	60	90	1	2				30		90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00		18.00				1.00		3.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	113	0		29	10	S5617_113_0	2	Generic	2	010000	1	2	2	1		111	01		110	1				30	60	90	1	2				30		90	30		31								11.00	22.00	33.00					5.00	10.00	15.00											11.00		33.00				5.00		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												
S5617	113	0		29	10	S5617_113_0	2	Preferred Brand	2	000101	1	2	3	1		111	01		110	1				30	60	90	1	2				30		90	30		31								45.00	90.00	135.00					40.00	80.00	120.00											45.00		135.00				40.00		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												
S5617	113	0		29	10	S5617_113_0	2	Non-Preferred Drug	2	100100	1	1	4	1		111	01		110	1				30	60	90	1	2				30		90	30		31											74.18	46	46	46				68.84	45	45	45										46		46				45		45			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	113	0		29	10	S5617_113_0	2	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	118	0		29	10	S5617_118_0	2	Preferred Generic	2	001000	1	2	1	1		111	01		110	1				30	60	90	1	2				30		90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											7.00		21.00				2.00		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												
S5617	118	0		29	10	S5617_118_0	2	Generic	2	010000	1	2	2	1		111	01		110	1				30	60	90	1	2				30		90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00		36.00				7.00		21.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	118	0		29	10	S5617_118_0	2	Preferred Brand	2	000101	1	2	3	1		111	01		110	1				30	60	90	1	2				30		90	30		31								45.00	90.00	135.00					40.00	80.00	120.00											45.00		135.00				40.00		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												
S5617	118	0		29	10	S5617_118_0	2	Non-Preferred Drug	2	100100	1	1	4	1		111	01		110	1				30	60	90	1	2				30		90	30		31											67.58	40	40	40				52.07	40	40	40										40		40				40		40			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	118	0		29	10	S5617_118_0	2	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	123	0		29	10	S5617_123_0	2	Preferred Generic	2	001000	1	2	1	1		111	01		110	1				30	60	90	1	2				30		90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											7.00		21.00				2.00		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												
S5617	123	0		29	10	S5617_123_0	2	Generic	2	010000	1	2	2	1		111	01		110	1				30	60	90	1	2				30		90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00		36.00				7.00		21.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	123	0		29	10	S5617_123_0	2	Preferred Brand	2	000101	1	2	3	1		111	01		110	1				30	60	90	1	2				30		90	30		31								45.00	90.00	135.00					40.00	80.00	120.00											45.00		135.00				40.00		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												
S5617	123	0		29	10	S5617_123_0	2	Non-Preferred Drug	2	100100	1	1	4	1		111	01		110	1				30	60	90	1	2				30		90	30		31											73.95	42	42	42				63.89	41	41	41										42		42				41		41			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	123	0		29	10	S5617_123_0	2	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	128	0		29	10	S5617_128_0	2	Preferred Generic	2	001000	1	2	1	1		111	01		110	1				30	60	90	1	2				30		90	30		31								9.00	18.00	27.00					4.00	8.00	12.00											9.00		27.00				4.00		12.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	128	0		29	10	S5617_128_0	2	Generic	2	010000	1	2	2	1		111	01		110	1				30	60	90	1	2				30		90	30		31								14.00	28.00	42.00					9.00	18.00	27.00											14.00		42.00				9.00		27.00				14.00				14.00			0.47	0.30		0.47	0.30	0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	128	0		29	10	S5617_128_0	2	Preferred Brand	2	000101	1	2	3	1		111	01		110	1				30	60	90	1	2				30		90	30		31								45.00	90.00	135.00					40.00	80.00	120.00											45.00		135.00				40.00		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												
S5617	128	0		29	10	S5617_128_0	2	Non-Preferred Drug	2	100100	1	1	4	1		111	01		110	1				30	60	90	1	2				30		90	30		31											76.88	47	47	47				61.39	43	43	43										47		47				43		43			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	128	0		29	10	S5617_128_0	2	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	133	0		29	10	S5617_133_0	2	Preferred Generic	2	001000	1	2	1	1		111	01		110	1				30	60	90	1	2				30		90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											7.00		21.00				2.00		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												
S5617	133	0		29	10	S5617_133_0	2	Generic	2	010000	1	2	2	1		111	01		110	1				30	60	90	1	2				30		90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00		36.00				7.00		21.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	133	0		29	10	S5617_133_0	2	Preferred Brand	2	000101	1	2	3	1		111	01		110	1				30	60	90	1	2				30		90	30		31								45.00	90.00	135.00					40.00	80.00	120.00											45.00		135.00				40.00		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												
S5617	133	0		29	10	S5617_133_0	2	Non-Preferred Drug	2	100100	1	1	4	1		111	01		110	1				30	60	90	1	2				30		90	30		31											82.28	43	43	43				62.57	40	40	40										43		43				40		40			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	133	0		29	10	S5617_133_0	2	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	138	0		29	10	S5617_138_0	2	Preferred Generic	2	001000	1	2	1	1		111	01		110	1				30	60	90	1	2				30		90	30		31								9.00	18.00	27.00					2.00	4.00	6.00											9.00		27.00				2.00		6.00				9.00				9.00			0.30	0.07		0.30	0.07	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	138	0		29	10	S5617_138_0	2	Generic	2	010000	1	2	2	1		111	01		110	1				30	60	90	1	2				30		90	30		31								14.00	28.00	42.00					7.00	14.00	21.00											14.00		42.00				7.00		21.00				14.00				14.00			0.47	0.23		0.47	0.23	0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	138	0		29	10	S5617_138_0	2	Preferred Brand	2	000101	1	2	3	1		111	01		110	1				30	60	90	1	2				30		90	30		31								45.00	90.00	135.00					40.00	80.00	120.00											45.00		135.00				40.00		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												
S5617	138	0		29	10	S5617_138_0	2	Non-Preferred Drug	2	100100	1	1	4	1		111	01		110	1				30	60	90	1	2				30		90	30		31											78.30	47	47	47				65.12	44	44	44										47		47				44		44			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	138	0		29	10	S5617_138_0	2	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	143	0		29	10	S5617_143_0	2	Preferred Generic	2	001000	1	2	1	1		111	01		110	1				30	60	90	1	2				30		90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											7.00		21.00				2.00		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												
S5617	143	0		29	10	S5617_143_0	2	Generic	2	010000	1	2	2	1		111	01		110	1				30	60	90	1	2				30		90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00		36.00				7.00		21.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	143	0		29	10	S5617_143_0	2	Preferred Brand	2	000101	1	2	3	1		111	01		110	1				30	60	90	1	2				30		90	30		31								45.00	90.00	135.00					40.00	80.00	120.00											45.00		135.00				40.00		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												
S5617	143	0		29	10	S5617_143_0	2	Non-Preferred Drug	2	100100	1	1	4	1		111	01		110	1				30	60	90	1	2				30		90	30		31											70.32	41	41	41				52.49	40	40	40										41		41				40		40			41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	143	0		29	10	S5617_143_0	2	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	148	0		29	10	S5617_148_0	2	Preferred Generic	2	001000	1	2	1	1		111	01		110	1				30	60	90	1	2				30		90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											7.00		21.00				2.00		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												
S5617	148	0		29	10	S5617_148_0	2	Generic	2	010000	1	2	2	1		111	01		110	1				30	60	90	1	2				30		90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00		36.00				7.00		21.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	148	0		29	10	S5617_148_0	2	Preferred Brand	2	000101	1	2	3	1		111	01		110	1				30	60	90	1	2				30		90	30		31								45.00	90.00	135.00					40.00	80.00	120.00											45.00		135.00				40.00		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												
S5617	148	0		29	10	S5617_148_0	2	Non-Preferred Drug	2	100100	1	1	4	1		111	01		110	1				30	60	90	1	2				30		90	30		31											87.84	49	49	49				69.57	45	45	45										49		49				45		45			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	148	0		29	10	S5617_148_0	2	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	153	0		29	10	S5617_153_0	2	Preferred Generic	2	001000	1	2	1	1		111	01		110	1				30	60	90	1	2				30		90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											7.00		21.00				2.00		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												
S5617	153	0		29	10	S5617_153_0	2	Generic	2	010000	1	2	2	1		111	01		110	1				30	60	90	1	2				30		90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00		36.00				7.00		21.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	153	0		29	10	S5617_153_0	2	Preferred Brand	2	000101	1	2	3	1		111	01		110	1				30	60	90	1	2				30		90	30		31								45.00	90.00	135.00					40.00	80.00	120.00											45.00		135.00				40.00		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												
S5617	153	0		29	10	S5617_153_0	2	Non-Preferred Drug	2	100100	1	1	4	1		111	01		110	1				30	60	90	1	2				30		90	30		31											74.09	40	40	40				58.73	40	40	40										40		40				40		40			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	153	0		29	10	S5617_153_0	2	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	158	0		29	10	S5617_158_0	2	Preferred Generic	2	001000	1	2	1	1		111	01		110	1				30	60	90	1	2				30		90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											7.00		21.00				2.00		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												
S5617	158	0		29	10	S5617_158_0	2	Generic	2	010000	1	2	2	1		111	01		110	1				30	60	90	1	2				30		90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00		36.00				7.00		21.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	158	0		29	10	S5617_158_0	2	Preferred Brand	2	000101	1	2	3	1		111	01		110	1				30	60	90	1	2				30		90	30		31								45.00	90.00	135.00					40.00	80.00	120.00											45.00		135.00				40.00		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												
S5617	158	0		29	10	S5617_158_0	2	Non-Preferred Drug	2	100100	1	1	4	1		111	01		110	1				30	60	90	1	2				30		90	30		31											86.55	43	43	43				71.37	41	41	41										43		43				41		41			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	158	0		29	10	S5617_158_0	2	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	163	0		29	10	S5617_163_0	2	Preferred Generic	2	001000	1	2	1	1		111	01		110	1				30	60	90	1	2				30		90	30		31								9.00	18.00	27.00					4.00	8.00	12.00											9.00		27.00				4.00		12.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	163	0		29	10	S5617_163_0	2	Generic	2	010000	1	2	2	1		111	01		110	1				30	60	90	1	2				30		90	30		31								14.00	28.00	42.00					9.00	18.00	27.00											14.00		42.00				9.00		27.00				14.00				14.00			0.47	0.30		0.47	0.30	0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	163	0		29	10	S5617_163_0	2	Preferred Brand	2	000101	1	2	3	1		111	01		110	1				30	60	90	1	2				30		90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	163	0		29	10	S5617_163_0	2	Non-Preferred Drug	2	100100	1	1	4	1		111	01		110	1				30	60	90	1	2				30		90	30		31											88.14	50	50	50				70.99	50	50	50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	163	0		29	10	S5617_163_0	2	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	214	0		29	10	S5617_214_0	2	Preferred Generic	2	001000	1	2	1	1		111	01		110	1				30	60	90	1	2				30		90	30		31								9.00	18.00	27.00					2.00	4.00	6.00											9.00		27.00				2.00		6.00				9.00				9.00			0.30	0.07		0.30	0.07	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	214	0		29	10	S5617_214_0	2	Generic	2	010000	1	2	2	1		111	01		110	1				30	60	90	1	2				30		90	30		31								14.00	28.00	42.00					7.00	14.00	21.00											14.00		42.00				7.00		21.00				14.00				14.00			0.47	0.23		0.47	0.23	0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	214	0		29	10	S5617_214_0	2	Preferred Brand	2	000101	1	2	3	1		111	01		110	1				30	60	90	1	2				30		90	30		31								45.00	90.00	135.00					40.00	80.00	120.00											45.00		135.00				40.00		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												
S5617	214	0		29	10	S5617_214_0	2	Non-Preferred Drug	2	100100	1	1	4	1		111	01		110	1				30	60	90	1	2				30		90	30		31											96.33	49	49	49				75.02	46	46	46										49		49				46		46			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	214	0		29	10	S5617_214_0	2	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	215	0		29	10	S5617_215_0	2	Preferred Generic	2	001000	1	2	1	1		111	01		110	1				30	60	90	1	2				30		90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											7.00		21.00				2.00		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												
S5617	215	0		29	10	S5617_215_0	2	Generic	2	010000	1	2	2	1		111	01		110	1				30	60	90	1	2				30		90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00		36.00				7.00		21.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	215	0		29	10	S5617_215_0	2	Preferred Brand	2	000101	1	2	3	1		111	01		110	1				30	60	90	1	2				30		90	30		31								45.00	90.00	135.00					40.00	80.00	120.00											45.00		135.00				40.00		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												
S5617	215	0		29	10	S5617_215_0	2	Non-Preferred Drug	2	100100	1	1	4	1		111	01		110	1				30	60	90	1	2				30		90	30		31											93.20	47	47	47				73.52	46	46	46										47		47				46		46			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	215	0		29	10	S5617_215_0	2	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	216	0		29	10	S5617_216_0	2	Preferred Generic	2	001000	1	2	1	1		111	01		110	1				30	60	90	1	2				30		90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											7.00		21.00				2.00		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												
S5617	216	0		29	10	S5617_216_0	2	Generic	2	010000	1	2	2	1		111	01		110	1				30	60	90	1	2				30		90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00		36.00				7.00		21.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	216	0		29	10	S5617_216_0	2	Preferred Brand	2	000101	1	2	3	1		111	01		110	1				30	60	90	1	2				30		90	30		31								45.00	90.00	135.00					40.00	80.00	120.00											45.00		135.00				40.00		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												
S5617	216	0		29	10	S5617_216_0	2	Non-Preferred Drug	2	100100	1	1	4	1		111	01		110	1				30	60	90	1	2				30		90	30		31											86.49	44	44	44				67.31	42	42	42										44		44				42		42			44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	216	0		29	10	S5617_216_0	2	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	217	0		29	10	S5617_217_0	2	Preferred Generic	2	001000	1	2	1	1		111	01		110	1				30	60	90	1	2				30		90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											7.00		21.00				2.00		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												
S5617	217	0		29	10	S5617_217_0	2	Generic	2	010000	1	2	2	1		111	01		110	1				30	60	90	1	2				30		90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00		36.00				7.00		21.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	217	0		29	10	S5617_217_0	2	Preferred Brand	2	000101	1	2	3	1		111	01		110	1				30	60	90	1	2				30		90	30		31								45.00	90.00	135.00					40.00	80.00	120.00											45.00		135.00				40.00		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												
S5617	217	0		29	10	S5617_217_0	2	Non-Preferred Drug	2	100100	1	1	4	1		111	01		110	1				30	60	90	1	2				30		90	30		31											97.72	46	46	46				78.86	45	45	45										46		46				45		45			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	217	0		29	10	S5617_217_0	2	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	218	0		29	10	S5617_218_0	2	Preferred Generic	2	001000	1	2	1	1		111	01		110	1				30	60	90	1	2				30		90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											7.00		21.00				2.00		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												
S5617	218	0		29	10	S5617_218_0	2	Generic	2	010000	1	2	2	1		111	01		110	1				30	60	90	1	2				30		90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00		36.00				7.00		21.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	218	0		29	10	S5617_218_0	2	Preferred Brand	2	000101	1	2	3	1		111	01		110	1				30	60	90	1	2				30		90	30		31								45.00	90.00	135.00					40.00	80.00	120.00											45.00		135.00				40.00		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												
S5617	218	0		29	10	S5617_218_0	2	Non-Preferred Drug	2	100100	1	1	4	1		111	01		110	1				30	60	90	1	2				30		90	30		31											87.20	44	44	44				70.17	42	42	42										44		44				42		42			44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	218	0		29	10	S5617_218_0	2	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	219	0		29	10	S5617_219_0	2	Preferred Generic	2	001000	1	2	1	1		111	01		110	1				30	60	90	1	2				30		90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00		18.00				1.00		3.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	219	0		29	10	S5617_219_0	2	Generic	2	010000	1	2	2	1		111	01		110	1				30	60	90	1	2				30		90	30		31								11.00	22.00	33.00					5.00	10.00	15.00											11.00		33.00				5.00		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												
S5617	219	0		29	10	S5617_219_0	2	Preferred Brand	2	000101	1	2	3	1		111	01		110	1				30	60	90	1	2				30		90	30		31								45.00	90.00	135.00					40.00	80.00	120.00											45.00		135.00				40.00		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												
S5617	219	0		29	10	S5617_219_0	2	Non-Preferred Drug	2	100100	1	1	4	1		111	01		110	1				30	60	90	1	2				30		90	30		31											83.18	47	47	47				68.51	46	46	46										47		47				46		46			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	219	0		29	10	S5617_219_0	2	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	220	0		29	10	S5617_220_0	2	Preferred Generic	2	001000	1	2	1	1		111	01		110	1				30	60	90	1	2				30		90	30		31								6.00	12.00	18.00					1.00	2.00	3.00											6.00		18.00				1.00		3.00				6.00				6.00			0.20	0.03		0.20	0.03	0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	220	0		29	10	S5617_220_0	2	Generic	2	010000	1	2	2	1		111	01		110	1				30	60	90	1	2				30		90	30		31								11.00	22.00	33.00					5.00	10.00	15.00											11.00		33.00				5.00		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												
S5617	220	0		29	10	S5617_220_0	2	Preferred Brand	2	000101	1	2	3	1		111	01		110	1				30	60	90	1	2				30		90	30		31								45.00	90.00	135.00					40.00	80.00	120.00											45.00		135.00				40.00		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												
S5617	220	0		29	10	S5617_220_0	2	Non-Preferred Drug	2	100100	1	1	4	1		111	01		110	1				30	60	90	1	2				30		90	30		31											86.57	48	48	48				72.11	47	47	47										48		48				47		47			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	220	0		29	10	S5617_220_0	2	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	221	0		29	10	S5617_221_0	2	Preferred Generic	2	001000	1	2	1	1		111	01		110	1				30	60	90	1	2				30		90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											7.00		21.00				2.00		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												
S5617	221	0		29	10	S5617_221_0	2	Generic	2	010000	1	2	2	1		111	01		110	1				30	60	90	1	2				30		90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00		36.00				7.00		21.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	221	0		29	10	S5617_221_0	2	Preferred Brand	2	000101	1	2	3	1		111	01		110	1				30	60	90	1	2				30		90	30		31								45.00	90.00	135.00					40.00	80.00	120.00											45.00		135.00				40.00		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												
S5617	221	0		29	10	S5617_221_0	2	Non-Preferred Drug	2	100100	1	1	4	1		111	01		110	1				30	60	90	1	2				30		90	30		31											98.43	48	48	48				73.73	45	45	45										48		48				45		45			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	221	0		29	10	S5617_221_0	2	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	222	0		29	10	S5617_222_0	2	Preferred Generic	2	001000	1	2	1	1		111	01		110	1				30	60	90	1	2				30		90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											7.00		21.00				2.00		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												
S5617	222	0		29	10	S5617_222_0	2	Generic	2	010000	1	2	2	1		111	01		110	1				30	60	90	1	2				30		90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00		36.00				7.00		21.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	222	0		29	10	S5617_222_0	2	Preferred Brand	2	000101	1	2	3	1		111	01		110	1				30	60	90	1	2				30		90	30		31								45.00	90.00	135.00					40.00	80.00	120.00											45.00		135.00				40.00		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												
S5617	222	0		29	10	S5617_222_0	2	Non-Preferred Drug	2	100100	1	1	4	1		111	01		110	1				30	60	90	1	2				30		90	30		31											83.18	41	41	41				64.26	40	40	40										41		41				40		40			41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	222	0		29	10	S5617_222_0	2	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	223	0		29	10	S5617_223_0	2	Preferred Generic	2	001000	1	2	1	1		111	01		110	1				30	60	90	1	2				30		90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											7.00		21.00				2.00		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												
S5617	223	0		29	10	S5617_223_0	2	Generic	2	010000	1	2	2	1		111	01		110	1				30	60	90	1	2				30		90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00		36.00				7.00		21.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	223	0		29	10	S5617_223_0	2	Preferred Brand	2	000101	1	2	3	1		111	01		110	1				30	60	90	1	2				30		90	30		31								45.00	90.00	135.00					40.00	80.00	120.00											45.00		135.00				40.00		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												
S5617	223	0		29	10	S5617_223_0	2	Non-Preferred Drug	2	100100	1	1	4	1		111	01		110	1				30	60	90	1	2				30		90	30		31											78.79	42	42	42				64.24	40	40	40										42		42				40		40			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	223	0		29	10	S5617_223_0	2	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	224	0		29	10	S5617_224_0	2	Preferred Generic	2	001000	1	2	1	1		111	01		110	1				30	60	90	1	2				30		90	30		31								9.00	18.00	27.00					2.00	4.00	6.00											9.00		27.00				2.00		6.00				9.00				9.00			0.30	0.07		0.30	0.07	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	224	0		29	10	S5617_224_0	2	Generic	2	010000	1	2	2	1		111	01		110	1				30	60	90	1	2				30		90	30		31								14.00	28.00	42.00					7.00	14.00	21.00											14.00		42.00				7.00		21.00				14.00				14.00			0.47	0.23		0.47	0.23	0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	224	0		29	10	S5617_224_0	2	Preferred Brand	2	000101	1	2	3	1		111	01		110	1				30	60	90	1	2				30		90	30		31								45.00	90.00	135.00					40.00	80.00	120.00											45.00		135.00				40.00		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												
S5617	224	0		29	10	S5617_224_0	2	Non-Preferred Drug	2	100100	1	1	4	1		111	01		110	1				30	60	90	1	2				30		90	30		31											83.94	46	46	46				67.34	44	44	44										46		46				44		44			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	224	0		29	10	S5617_224_0	2	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	225	0		29	10	S5617_225_0	2	Preferred Generic	2	001000	1	2	1	1		111	01		110	1				30	60	90	1	2				30		90	30		31								9.00	18.00	27.00					2.00	4.00	6.00											9.00		27.00				2.00		6.00				9.00				9.00			0.30	0.07		0.30	0.07	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	225	0		29	10	S5617_225_0	2	Generic	2	010000	1	2	2	1		111	01		110	1				30	60	90	1	2				30		90	30		31								14.00	28.00	42.00					7.00	14.00	21.00											14.00		42.00				7.00		21.00				14.00				14.00			0.47	0.23		0.47	0.23	0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	225	0		29	10	S5617_225_0	2	Preferred Brand	2	000101	1	2	3	1		111	01		110	1				30	60	90	1	2				30		90	30		31								45.00	90.00	135.00					40.00	80.00	120.00											45.00		135.00				40.00		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												
S5617	225	0		29	10	S5617_225_0	2	Non-Preferred Drug	2	100100	1	1	4	1		111	01		110	1				30	60	90	1	2				30		90	30		31											82.75	50	50	50				67.32	48	48	48										50		50				48		48			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	225	0		29	10	S5617_225_0	2	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	226	0		29	10	S5617_226_0	2	Preferred Generic	2	001000	1	2	1	1		111	01		110	1				30	60	90	1	2				30		90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											7.00		21.00				2.00		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												
S5617	226	0		29	10	S5617_226_0	2	Generic	2	010000	1	2	2	1		111	01		110	1				30	60	90	1	2				30		90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00		36.00				7.00		21.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	226	0		29	10	S5617_226_0	2	Preferred Brand	2	000101	1	2	3	1		111	01		110	1				30	60	90	1	2				30		90	30		31								45.00	90.00	135.00					40.00	80.00	120.00											45.00		135.00				40.00		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												
S5617	226	0		29	10	S5617_226_0	2	Non-Preferred Drug	2	100100	1	1	4	1		111	01		110	1				30	60	90	1	2				30		90	30		31											81.65	46	46	46				65.58	45	45	45										46		46				45		45			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	226	0		29	10	S5617_226_0	2	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	227	0		29	10	S5617_227_0	2	Preferred Generic	2	001000	1	2	1	1		111	01		110	1				30	60	90	1	2				30		90	30		31								7.00	14.00	21.00					2.00	4.00	6.00											7.00		21.00				2.00		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												
S5617	227	0		29	10	S5617_227_0	2	Generic	2	010000	1	2	2	1		111	01		110	1				30	60	90	1	2				30		90	30		31								12.00	24.00	36.00					7.00	14.00	21.00											12.00		36.00				7.00		21.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	227	0		29	10	S5617_227_0	2	Preferred Brand	2	000101	1	2	3	1		111	01		110	1				30	60	90	1	2				30		90	30		31								45.00	90.00	135.00					40.00	80.00	120.00											45.00		135.00				40.00		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												
S5617	227	0		29	10	S5617_227_0	2	Non-Preferred Drug	2	100100	1	1	4	1		111	01		110	1				30	60	90	1	2				30		90	30		31											75.90	49	49	49				76.40	46	46	46										49		49				46		46			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	227	0		29	10	S5617_227_0	2	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	246	0		29	10	S5617_246_0	2	Preferred Generic	4	001000	1	2	1	1		111	01		110	1				30	60	90	1	2				30		90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00		45.00				5.00		15.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	246	0		29	10	S5617_246_0	2	Preferred Generic	4	001000	1	2	1	3		111	01		110	1				30	60	90	1	2				30		90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00		45.00				5.00		15.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5617	246	0		29	10	S5617_246_0	2	Generic	4	010000	1	2	2	1		111	01		110	1				30	60	90	1	2				30		90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00		60.00				10.00		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												
S5617	246	0		29	10	S5617_246_0	2	Generic	4	010000	1	2	2	3		111	01		110	1				30	60	90	1	2				30		90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00		60.00				10.00		30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5617	246	0		29	10	S5617_246_0	2	Preferred Brand	4	000101	1	2	3	1		111	01		110	1				30	60	90	1	2				30		90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	246	0		29	10	S5617_246_0	2	Non-Preferred Drug	4	100100	1	1	4	1		111	01		110	1				30	60	90	1	2				30		90	30		31											48.30	50	50	50				36.96	50	50	50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	246	0		29	10	S5617_246_0	2	Specialty Tier	4	010010	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												
S5617	247	0		29	10	S5617_247_0	2	Preferred Generic	4	001000	1	2	1	1		111	01		110	1				30	60	90	1	2				30		90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00		45.00				5.00		15.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	247	0		29	10	S5617_247_0	2	Preferred Generic	4	001000	1	2	1	3		111	01		110	1				30	60	90	1	2				30		90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00		45.00				5.00		15.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5617	247	0		29	10	S5617_247_0	2	Generic	4	010000	1	2	2	1		111	01		110	1				30	60	90	1	2				30		90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00		60.00				10.00		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												
S5617	247	0		29	10	S5617_247_0	2	Generic	4	010000	1	2	2	3		111	01		110	1				30	60	90	1	2				30		90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00		60.00				10.00		30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5617	247	0		29	10	S5617_247_0	2	Preferred Brand	4	000101	1	2	3	1		111	01		110	1				30	60	90	1	2				30		90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	247	0		29	10	S5617_247_0	2	Non-Preferred Drug	4	100100	1	1	4	1		111	01		110	1				30	60	90	1	2				30		90	30		31											63.37	50	50	50				52.81	50	50	50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	247	0		29	10	S5617_247_0	2	Specialty Tier	4	010010	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												
S5617	248	0		29	10	S5617_248_0	2	Preferred Generic	4	001000	1	2	1	1		111	01		110	1				30	60	90	1	2				30		90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00		45.00				5.00		15.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	248	0		29	10	S5617_248_0	2	Preferred Generic	4	001000	1	2	1	3		111	01		110	1				30	60	90	1	2				30		90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00		45.00				5.00		15.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5617	248	0		29	10	S5617_248_0	2	Generic	4	010000	1	2	2	1		111	01		110	1				30	60	90	1	2				30		90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00		60.00				10.00		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												
S5617	248	0		29	10	S5617_248_0	2	Generic	4	010000	1	2	2	3		111	01		110	1				30	60	90	1	2				30		90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00		60.00				10.00		30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5617	248	0		29	10	S5617_248_0	2	Preferred Brand	4	000101	1	2	3	1		111	01		110	1				30	60	90	1	2				30		90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	248	0		29	10	S5617_248_0	2	Non-Preferred Drug	4	100100	1	1	4	1		111	01		110	1				30	60	90	1	2				30		90	30		31											59.58	50	50	50				49.68	50	50	50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	248	0		29	10	S5617_248_0	2	Specialty Tier	4	010010	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												
S5617	249	0		29	10	S5617_249_0	2	Preferred Generic	4	001000	1	2	1	1		111	01		110	1				30	60	90	1	2				30		90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00		45.00				5.00		15.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	249	0		29	10	S5617_249_0	2	Preferred Generic	4	001000	1	2	1	3		111	01		110	1				30	60	90	1	2				30		90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00		45.00				5.00		15.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5617	249	0		29	10	S5617_249_0	2	Generic	4	010000	1	2	2	1		111	01		110	1				30	60	90	1	2				30		90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00		60.00				10.00		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												
S5617	249	0		29	10	S5617_249_0	2	Generic	4	010000	1	2	2	3		111	01		110	1				30	60	90	1	2				30		90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00		60.00				10.00		30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5617	249	0		29	10	S5617_249_0	2	Preferred Brand	4	000101	1	2	3	1		111	01		110	1				30	60	90	1	2				30		90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	249	0		29	10	S5617_249_0	2	Non-Preferred Drug	4	100100	1	1	4	1		111	01		110	1				30	60	90	1	2				30		90	30		31											50.99	50	50	50				43.42	50	50	50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	249	0		29	10	S5617_249_0	2	Specialty Tier	4	010010	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												
S5617	250	0		29	10	S5617_250_0	2	Preferred Generic	4	001000	1	2	1	1		111	01		110	1				30	60	90	1	2				30		90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00		45.00				5.00		15.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	250	0		29	10	S5617_250_0	2	Preferred Generic	4	001000	1	2	1	3		111	01		110	1				30	60	90	1	2				30		90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00		45.00				5.00		15.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5617	250	0		29	10	S5617_250_0	2	Generic	4	010000	1	2	2	1		111	01		110	1				30	60	90	1	2				30		90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00		60.00				10.00		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												
S5617	250	0		29	10	S5617_250_0	2	Generic	4	010000	1	2	2	3		111	01		110	1				30	60	90	1	2				30		90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00		60.00				10.00		30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5617	250	0		29	10	S5617_250_0	2	Preferred Brand	4	000101	1	2	3	1		111	01		110	1				30	60	90	1	2				30		90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	250	0		29	10	S5617_250_0	2	Non-Preferred Drug	4	100100	1	1	4	1		111	01		110	1				30	60	90	1	2				30		90	30		31											49.79	50	50	50				44.41	50	50	50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	250	0		29	10	S5617_250_0	2	Specialty Tier	4	010010	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												
S5617	251	0		29	10	S5617_251_0	2	Preferred Generic	4	001000	1	2	1	1		111	01		110	1				30	60	90	1	2				30		90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00		45.00				5.00		15.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	251	0		29	10	S5617_251_0	2	Preferred Generic	4	001000	1	2	1	3		111	01		110	1				30	60	90	1	2				30		90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00		45.00				5.00		15.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5617	251	0		29	10	S5617_251_0	2	Generic	4	010000	1	2	2	1		111	01		110	1				30	60	90	1	2				30		90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00		60.00				10.00		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												
S5617	251	0		29	10	S5617_251_0	2	Generic	4	010000	1	2	2	3		111	01		110	1				30	60	90	1	2				30		90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00		60.00				10.00		30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5617	251	0		29	10	S5617_251_0	2	Preferred Brand	4	000101	1	2	3	1		111	01		110	1				30	60	90	1	2				30		90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	251	0		29	10	S5617_251_0	2	Non-Preferred Drug	4	100100	1	1	4	1		111	01		110	1				30	60	90	1	2				30		90	30		31											44.49	50	50	50				38.64	50	50	50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	251	0		29	10	S5617_251_0	2	Specialty Tier	4	010010	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												
S5617	252	0		29	10	S5617_252_0	2	Preferred Generic	4	001000	1	2	1	1		111	01		110	1				30	60	90	1	2				30		90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00		45.00				5.00		15.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	252	0		29	10	S5617_252_0	2	Preferred Generic	4	001000	1	2	1	3		111	01		110	1				30	60	90	1	2				30		90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00		45.00				5.00		15.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5617	252	0		29	10	S5617_252_0	2	Generic	4	010000	1	2	2	1		111	01		110	1				30	60	90	1	2				30		90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00		60.00				10.00		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												
S5617	252	0		29	10	S5617_252_0	2	Generic	4	010000	1	2	2	3		111	01		110	1				30	60	90	1	2				30		90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00		60.00				10.00		30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5617	252	0		29	10	S5617_252_0	2	Preferred Brand	4	000101	1	2	3	1		111	01		110	1				30	60	90	1	2				30		90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	252	0		29	10	S5617_252_0	2	Non-Preferred Drug	4	100100	1	1	4	1		111	01		110	1				30	60	90	1	2				30		90	30		31											58.31	50	50	50				49.33	50	50	50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	252	0		29	10	S5617_252_0	2	Specialty Tier	4	010010	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												
S5617	253	0		29	10	S5617_253_0	2	Preferred Generic	4	001000	1	2	1	1		111	01		110	1				30	60	90	1	2				30		90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00		45.00				5.00		15.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	253	0		29	10	S5617_253_0	2	Preferred Generic	4	001000	1	2	1	3		111	01		110	1				30	60	90	1	2				30		90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00		45.00				5.00		15.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5617	253	0		29	10	S5617_253_0	2	Generic	4	010000	1	2	2	1		111	01		110	1				30	60	90	1	2				30		90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00		60.00				10.00		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												
S5617	253	0		29	10	S5617_253_0	2	Generic	4	010000	1	2	2	3		111	01		110	1				30	60	90	1	2				30		90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00		60.00				10.00		30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5617	253	0		29	10	S5617_253_0	2	Preferred Brand	4	000101	1	2	3	1		111	01		110	1				30	60	90	1	2				30		90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	253	0		29	10	S5617_253_0	2	Non-Preferred Drug	4	100100	1	1	4	1		111	01		110	1				30	60	90	1	2				30		90	30		31											52.48	50	50	50				44.69	50	50	50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	253	0		29	10	S5617_253_0	2	Specialty Tier	4	010010	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												
S5617	254	0		29	10	S5617_254_0	2	Preferred Generic	4	001000	1	2	1	1		111	01		110	1				30	60	90	1	2				30		90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00		45.00				5.00		15.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	254	0		29	10	S5617_254_0	2	Preferred Generic	4	001000	1	2	1	3		111	01		110	1				30	60	90	1	2				30		90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00		45.00				5.00		15.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5617	254	0		29	10	S5617_254_0	2	Generic	4	010000	1	2	2	1		111	01		110	1				30	60	90	1	2				30		90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00		60.00				10.00		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												
S5617	254	0		29	10	S5617_254_0	2	Generic	4	010000	1	2	2	3		111	01		110	1				30	60	90	1	2				30		90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00		60.00				10.00		30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5617	254	0		29	10	S5617_254_0	2	Preferred Brand	4	000101	1	2	3	1		111	01		110	1				30	60	90	1	2				30		90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	254	0		29	10	S5617_254_0	2	Non-Preferred Drug	4	100100	1	1	4	1		111	01		110	1				30	60	90	1	2				30		90	30		31											54.20	50	50	50				47.36	50	50	50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	254	0		29	10	S5617_254_0	2	Specialty Tier	4	010010	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												
S5617	255	0		29	10	S5617_255_0	2	Preferred Generic	4	001000	1	2	1	1		111	01		110	1				30	60	90	1	2				30		90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00		45.00				5.00		15.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	255	0		29	10	S5617_255_0	2	Preferred Generic	4	001000	1	2	1	3		111	01		110	1				30	60	90	1	2				30		90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00		45.00				5.00		15.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5617	255	0		29	10	S5617_255_0	2	Generic	4	010000	1	2	2	1		111	01		110	1				30	60	90	1	2				30		90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00		60.00				10.00		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												
S5617	255	0		29	10	S5617_255_0	2	Generic	4	010000	1	2	2	3		111	01		110	1				30	60	90	1	2				30		90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00		60.00				10.00		30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5617	255	0		29	10	S5617_255_0	2	Preferred Brand	4	000101	1	2	3	1		111	01		110	1				30	60	90	1	2				30		90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	255	0		29	10	S5617_255_0	2	Non-Preferred Drug	4	100100	1	1	4	1		111	01		110	1				30	60	90	1	2				30		90	30		31											46.10	50	50	50				40.12	50	50	50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	255	0		29	10	S5617_255_0	2	Specialty Tier	4	010010	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												
S5617	256	0		29	10	S5617_256_0	2	Preferred Generic	4	001000	1	2	1	1		111	01		110	1				30	60	90	1	2				30		90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00		45.00				5.00		15.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	256	0		29	10	S5617_256_0	2	Preferred Generic	4	001000	1	2	1	3		111	01		110	1				30	60	90	1	2				30		90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00		45.00				5.00		15.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5617	256	0		29	10	S5617_256_0	2	Generic	4	010000	1	2	2	1		111	01		110	1				30	60	90	1	2				30		90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00		60.00				10.00		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												
S5617	256	0		29	10	S5617_256_0	2	Generic	4	010000	1	2	2	3		111	01		110	1				30	60	90	1	2				30		90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00		60.00				10.00		30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5617	256	0		29	10	S5617_256_0	2	Preferred Brand	4	000101	1	2	3	1		111	01		110	1				30	60	90	1	2				30		90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	256	0		29	10	S5617_256_0	2	Non-Preferred Drug	4	100100	1	1	4	1		111	01		110	1				30	60	90	1	2				30		90	30		31											50.97	50	50	50				44.09	50	50	50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	256	0		29	10	S5617_256_0	2	Specialty Tier	4	010010	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												
S5617	257	0		29	10	S5617_257_0	2	Preferred Generic	4	001000	1	2	1	1		111	01		110	1				30	60	90	1	2				30		90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00		45.00				5.00		15.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	257	0		29	10	S5617_257_0	2	Preferred Generic	4	001000	1	2	1	3		111	01		110	1				30	60	90	1	2				30		90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00		45.00				5.00		15.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5617	257	0		29	10	S5617_257_0	2	Generic	4	010000	1	2	2	1		111	01		110	1				30	60	90	1	2				30		90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00		60.00				10.00		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												
S5617	257	0		29	10	S5617_257_0	2	Generic	4	010000	1	2	2	3		111	01		110	1				30	60	90	1	2				30		90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00		60.00				10.00		30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5617	257	0		29	10	S5617_257_0	2	Preferred Brand	4	000101	1	2	3	1		111	01		110	1				30	60	90	1	2				30		90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	257	0		29	10	S5617_257_0	2	Non-Preferred Drug	4	100100	1	1	4	1		111	01		110	1				30	60	90	1	2				30		90	30		31											47.30	50	50	50				43.73	50	50	50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	257	0		29	10	S5617_257_0	2	Specialty Tier	4	010010	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												
S5617	258	0		29	10	S5617_258_0	2	Preferred Generic	4	001000	1	2	1	1		111	01		110	1				30	60	90	1	2				30		90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00		45.00				5.00		15.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	258	0		29	10	S5617_258_0	2	Preferred Generic	4	001000	1	2	1	3		111	01		110	1				30	60	90	1	2				30		90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00		45.00				5.00		15.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5617	258	0		29	10	S5617_258_0	2	Generic	4	010000	1	2	2	1		111	01		110	1				30	60	90	1	2				30		90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00		60.00				10.00		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												
S5617	258	0		29	10	S5617_258_0	2	Generic	4	010000	1	2	2	3		111	01		110	1				30	60	90	1	2				30		90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00		60.00				10.00		30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5617	258	0		29	10	S5617_258_0	2	Preferred Brand	4	000101	1	2	3	1		111	01		110	1				30	60	90	1	2				30		90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	258	0		29	10	S5617_258_0	2	Non-Preferred Drug	4	100100	1	1	4	1		111	01		110	1				30	60	90	1	2				30		90	30		31											60.37	50	50	50				48.11	50	50	50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	258	0		29	10	S5617_258_0	2	Specialty Tier	4	010010	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												
S5617	259	0		29	10	S5617_259_0	2	Preferred Generic	4	001000	1	2	1	1		111	01		110	1				30	60	90	1	2				30		90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00		45.00				5.00		15.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	259	0		29	10	S5617_259_0	2	Preferred Generic	4	001000	1	2	1	3		111	01		110	1				30	60	90	1	2				30		90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00		45.00				5.00		15.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5617	259	0		29	10	S5617_259_0	2	Generic	4	010000	1	2	2	1		111	01		110	1				30	60	90	1	2				30		90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00		60.00				10.00		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												
S5617	259	0		29	10	S5617_259_0	2	Generic	4	010000	1	2	2	3		111	01		110	1				30	60	90	1	2				30		90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00		60.00				10.00		30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5617	259	0		29	10	S5617_259_0	2	Preferred Brand	4	000101	1	2	3	1		111	01		110	1				30	60	90	1	2				30		90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	259	0		29	10	S5617_259_0	2	Non-Preferred Drug	4	100100	1	1	4	1		111	01		110	1				30	60	90	1	2				30		90	30		31											55.93	50	50	50				46.23	50	50	50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	259	0		29	10	S5617_259_0	2	Specialty Tier	4	010010	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												
S5617	260	0		29	10	S5617_260_0	2	Preferred Generic	4	001000	1	2	1	1		111	01		110	1				30	60	90	1	2				30		90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00		45.00				5.00		15.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	260	0		29	10	S5617_260_0	2	Preferred Generic	4	001000	1	2	1	3		111	01		110	1				30	60	90	1	2				30		90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00		45.00				5.00		15.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5617	260	0		29	10	S5617_260_0	2	Generic	4	010000	1	2	2	1		111	01		110	1				30	60	90	1	2				30		90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00		60.00				10.00		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												
S5617	260	0		29	10	S5617_260_0	2	Generic	4	010000	1	2	2	3		111	01		110	1				30	60	90	1	2				30		90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00		60.00				10.00		30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5617	260	0		29	10	S5617_260_0	2	Preferred Brand	4	000101	1	2	3	1		111	01		110	1				30	60	90	1	2				30		90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	260	0		29	10	S5617_260_0	2	Non-Preferred Drug	4	100100	1	1	4	1		111	01		110	1				30	60	90	1	2				30		90	30		31											55.25	50	50	50				43.61	50	50	50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	260	0		29	10	S5617_260_0	2	Specialty Tier	4	010010	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												
S5617	261	0		29	10	S5617_261_0	2	Preferred Generic	4	001000	1	2	1	1		111	01		110	1				30	60	90	1	2				30		90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00		45.00				5.00		15.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	261	0		29	10	S5617_261_0	2	Preferred Generic	4	001000	1	2	1	3		111	01		110	1				30	60	90	1	2				30		90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00		45.00				5.00		15.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5617	261	0		29	10	S5617_261_0	2	Generic	4	010000	1	2	2	1		111	01		110	1				30	60	90	1	2				30		90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00		60.00				10.00		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												
S5617	261	0		29	10	S5617_261_0	2	Generic	4	010000	1	2	2	3		111	01		110	1				30	60	90	1	2				30		90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00		60.00				10.00		30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5617	261	0		29	10	S5617_261_0	2	Preferred Brand	4	000101	1	2	3	1		111	01		110	1				30	60	90	1	2				30		90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	261	0		29	10	S5617_261_0	2	Non-Preferred Drug	4	100100	1	1	4	1		111	01		110	1				30	60	90	1	2				30		90	30		31											56.85	50	50	50				50.75	50	50	50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	261	0		29	10	S5617_261_0	2	Specialty Tier	4	010010	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												
S5617	262	0		29	10	S5617_262_0	2	Preferred Generic	4	001000	1	2	1	1		111	01		110	1				30	60	90	1	2				30		90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00		45.00				5.00		15.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	262	0		29	10	S5617_262_0	2	Preferred Generic	4	001000	1	2	1	3		111	01		110	1				30	60	90	1	2				30		90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00		45.00				5.00		15.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5617	262	0		29	10	S5617_262_0	2	Generic	4	010000	1	2	2	1		111	01		110	1				30	60	90	1	2				30		90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00		60.00				10.00		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												
S5617	262	0		29	10	S5617_262_0	2	Generic	4	010000	1	2	2	3		111	01		110	1				30	60	90	1	2				30		90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00		60.00				10.00		30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5617	262	0		29	10	S5617_262_0	2	Preferred Brand	4	000101	1	2	3	1		111	01		110	1				30	60	90	1	2				30		90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	262	0		29	10	S5617_262_0	2	Non-Preferred Drug	4	100100	1	1	4	1		111	01		110	1				30	60	90	1	2				30		90	30		31											52.35	50	50	50				44.49	50	50	50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	262	0		29	10	S5617_262_0	2	Specialty Tier	4	010010	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												
S5617	263	0		29	10	S5617_263_0	2	Preferred Generic	4	001000	1	2	1	1		111	01		110	1				30	60	90	1	2				30		90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00		45.00				5.00		15.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	263	0		29	10	S5617_263_0	2	Preferred Generic	4	001000	1	2	1	3		111	01		110	1				30	60	90	1	2				30		90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00		45.00				5.00		15.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5617	263	0		29	10	S5617_263_0	2	Generic	4	010000	1	2	2	1		111	01		110	1				30	60	90	1	2				30		90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00		60.00				10.00		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												
S5617	263	0		29	10	S5617_263_0	2	Generic	4	010000	1	2	2	3		111	01		110	1				30	60	90	1	2				30		90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00		60.00				10.00		30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5617	263	0		29	10	S5617_263_0	2	Preferred Brand	4	000101	1	2	3	1		111	01		110	1				30	60	90	1	2				30		90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	263	0		29	10	S5617_263_0	2	Non-Preferred Drug	4	100100	1	1	4	1		111	01		110	1				30	60	90	1	2				30		90	30		31											46.81	50	50	50				42.09	50	50	50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	263	0		29	10	S5617_263_0	2	Specialty Tier	4	010010	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												
S5617	264	0		29	10	S5617_264_0	2	Preferred Generic	4	001000	1	2	1	1		111	01		110	1				30	60	90	1	2				30		90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00		45.00				5.00		15.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	264	0		29	10	S5617_264_0	2	Preferred Generic	4	001000	1	2	1	3		111	01		110	1				30	60	90	1	2				30		90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00		45.00				5.00		15.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5617	264	0		29	10	S5617_264_0	2	Generic	4	010000	1	2	2	1		111	01		110	1				30	60	90	1	2				30		90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00		60.00				10.00		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												
S5617	264	0		29	10	S5617_264_0	2	Generic	4	010000	1	2	2	3		111	01		110	1				30	60	90	1	2				30		90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00		60.00				10.00		30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5617	264	0		29	10	S5617_264_0	2	Preferred Brand	4	000101	1	2	3	1		111	01		110	1				30	60	90	1	2				30		90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	264	0		29	10	S5617_264_0	2	Non-Preferred Drug	4	100100	1	1	4	1		111	01		110	1				30	60	90	1	2				30		90	30		31											43.59	50	50	50				39.86	50	50	50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	264	0		29	10	S5617_264_0	2	Specialty Tier	4	010010	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												
S5617	265	0		29	10	S5617_265_0	2	Preferred Generic	4	001000	1	2	1	1		111	01		110	1				30	60	90	1	2				30		90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00		45.00				5.00		15.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	265	0		29	10	S5617_265_0	2	Preferred Generic	4	001000	1	2	1	3		111	01		110	1				30	60	90	1	2				30		90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00		45.00				5.00		15.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5617	265	0		29	10	S5617_265_0	2	Generic	4	010000	1	2	2	1		111	01		110	1				30	60	90	1	2				30		90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00		60.00				10.00		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												
S5617	265	0		29	10	S5617_265_0	2	Generic	4	010000	1	2	2	3		111	01		110	1				30	60	90	1	2				30		90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00		60.00				10.00		30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5617	265	0		29	10	S5617_265_0	2	Preferred Brand	4	000101	1	2	3	1		111	01		110	1				30	60	90	1	2				30		90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	265	0		29	10	S5617_265_0	2	Non-Preferred Drug	4	100100	1	1	4	1		111	01		110	1				30	60	90	1	2				30		90	30		31											50.84	50	50	50				44.31	50	50	50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	265	0		29	10	S5617_265_0	2	Specialty Tier	4	010010	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												
S5617	266	0		29	10	S5617_266_0	2	Preferred Generic	4	001000	1	2	1	1		111	01		110	1				30	60	90	1	2				30		90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00		45.00				5.00		15.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	266	0		29	10	S5617_266_0	2	Preferred Generic	4	001000	1	2	1	3		111	01		110	1				30	60	90	1	2				30		90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00		45.00				5.00		15.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5617	266	0		29	10	S5617_266_0	2	Generic	4	010000	1	2	2	1		111	01		110	1				30	60	90	1	2				30		90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00		60.00				10.00		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												
S5617	266	0		29	10	S5617_266_0	2	Generic	4	010000	1	2	2	3		111	01		110	1				30	60	90	1	2				30		90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00		60.00				10.00		30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5617	266	0		29	10	S5617_266_0	2	Preferred Brand	4	000101	1	2	3	1		111	01		110	1				30	60	90	1	2				30		90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	266	0		29	10	S5617_266_0	2	Non-Preferred Drug	4	100100	1	1	4	1		111	01		110	1				30	60	90	1	2				30		90	30		31											43.71	50	50	50				40.53	50	50	50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	266	0		29	10	S5617_266_0	2	Specialty Tier	4	010010	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												
S5617	267	0		29	10	S5617_267_0	2	Preferred Generic	4	001000	1	2	1	1		111	01		110	1				30	60	90	1	2				30		90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00		45.00				5.00		15.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	267	0		29	10	S5617_267_0	2	Preferred Generic	4	001000	1	2	1	3		111	01		110	1				30	60	90	1	2				30		90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00		45.00				5.00		15.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5617	267	0		29	10	S5617_267_0	2	Generic	4	010000	1	2	2	1		111	01		110	1				30	60	90	1	2				30		90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00		60.00				10.00		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												
S5617	267	0		29	10	S5617_267_0	2	Generic	4	010000	1	2	2	3		111	01		110	1				30	60	90	1	2				30		90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00		60.00				10.00		30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5617	267	0		29	10	S5617_267_0	2	Preferred Brand	4	000101	1	2	3	1		111	01		110	1				30	60	90	1	2				30		90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	267	0		29	10	S5617_267_0	2	Non-Preferred Drug	4	100100	1	1	4	1		111	01		110	1				30	60	90	1	2				30		90	30		31											51.66	50	50	50				42.89	50	50	50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	267	0		29	10	S5617_267_0	2	Specialty Tier	4	010010	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												
S5617	268	0		29	10	S5617_268_0	2	Preferred Generic	4	001000	1	2	1	1		111	01		110	1				30	60	90	1	2				30		90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00		45.00				5.00		15.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	268	0		29	10	S5617_268_0	2	Preferred Generic	4	001000	1	2	1	3		111	01		110	1				30	60	90	1	2				30		90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00		45.00				5.00		15.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5617	268	0		29	10	S5617_268_0	2	Generic	4	010000	1	2	2	1		111	01		110	1				30	60	90	1	2				30		90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00		60.00				10.00		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												
S5617	268	0		29	10	S5617_268_0	2	Generic	4	010000	1	2	2	3		111	01		110	1				30	60	90	1	2				30		90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00		60.00				10.00		30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5617	268	0		29	10	S5617_268_0	2	Preferred Brand	4	000101	1	2	3	1		111	01		110	1				30	60	90	1	2				30		90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	268	0		29	10	S5617_268_0	2	Non-Preferred Drug	4	100100	1	1	4	1		111	01		110	1				30	60	90	1	2				30		90	30		31											44.04	50	50	50				41.85	50	50	50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	268	0		29	10	S5617_268_0	2	Specialty Tier	4	010010	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												
S5617	269	0		29	10	S5617_269_0	2	Preferred Generic	4	001000	1	2	1	1		111	01		110	1				30	60	90	1	2				30		90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00		45.00				5.00		15.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	269	0		29	10	S5617_269_0	2	Preferred Generic	4	001000	1	2	1	3		111	01		110	1				30	60	90	1	2				30		90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00		45.00				5.00		15.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5617	269	0		29	10	S5617_269_0	2	Generic	4	010000	1	2	2	1		111	01		110	1				30	60	90	1	2				30		90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00		60.00				10.00		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												
S5617	269	0		29	10	S5617_269_0	2	Generic	4	010000	1	2	2	3		111	01		110	1				30	60	90	1	2				30		90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00		60.00				10.00		30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5617	269	0		29	10	S5617_269_0	2	Preferred Brand	4	000101	1	2	3	1		111	01		110	1				30	60	90	1	2				30		90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	269	0		29	10	S5617_269_0	2	Non-Preferred Drug	4	100100	1	1	4	1		111	01		110	1				30	60	90	1	2				30		90	30		31											49.63	50	50	50				45.14	50	50	50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	269	0		29	10	S5617_269_0	2	Specialty Tier	4	010010	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												
S5617	270	0		29	10	S5617_270_0	2	Preferred Generic	4	001000	1	2	1	1		111	01		110	1				30	60	90	1	2				30		90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00		45.00				5.00		15.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	270	0		29	10	S5617_270_0	2	Preferred Generic	4	001000	1	2	1	3		111	01		110	1				30	60	90	1	2				30		90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00		45.00				5.00		15.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5617	270	0		29	10	S5617_270_0	2	Generic	4	010000	1	2	2	1		111	01		110	1				30	60	90	1	2				30		90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00		60.00				10.00		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												
S5617	270	0		29	10	S5617_270_0	2	Generic	4	010000	1	2	2	3		111	01		110	1				30	60	90	1	2				30		90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00		60.00				10.00		30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5617	270	0		29	10	S5617_270_0	2	Preferred Brand	4	000101	1	2	3	1		111	01		110	1				30	60	90	1	2				30		90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	270	0		29	10	S5617_270_0	2	Non-Preferred Drug	4	100100	1	1	4	1		111	01		110	1				30	60	90	1	2				30		90	30		31											48.92	50	50	50				44.84	50	50	50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	270	0		29	10	S5617_270_0	2	Specialty Tier	4	010010	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												
S5617	271	0		29	10	S5617_271_0	2	Preferred Generic	4	001000	1	2	1	1		111	01		110	1				30	60	90	1	2				30		90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00		45.00				5.00		15.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	271	0		29	10	S5617_271_0	2	Preferred Generic	4	001000	1	2	1	3		111	01		110	1				30	60	90	1	2				30		90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00		45.00				5.00		15.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5617	271	0		29	10	S5617_271_0	2	Generic	4	010000	1	2	2	1		111	01		110	1				30	60	90	1	2				30		90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00		60.00				10.00		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												
S5617	271	0		29	10	S5617_271_0	2	Generic	4	010000	1	2	2	3		111	01		110	1				30	60	90	1	2				30		90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00		60.00				10.00		30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5617	271	0		29	10	S5617_271_0	2	Preferred Brand	4	000101	1	2	3	1		111	01		110	1				30	60	90	1	2				30		90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	271	0		29	10	S5617_271_0	2	Non-Preferred Drug	4	100100	1	1	4	1		111	01		110	1				30	60	90	1	2				30		90	30		31											40.48	50	50	50				38.61	50	50	50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	271	0		29	10	S5617_271_0	2	Specialty Tier	4	010010	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												
S5617	272	0		29	10	S5617_272_0	2	Preferred Generic	4	001000	1	2	1	1		111	01		110	1				30	60	90	1	2				30		90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00		45.00				5.00		15.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	272	0		29	10	S5617_272_0	2	Preferred Generic	4	001000	1	2	1	3		111	01		110	1				30	60	90	1	2				30		90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00		45.00				5.00		15.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5617	272	0		29	10	S5617_272_0	2	Generic	4	010000	1	2	2	1		111	01		110	1				30	60	90	1	2				30		90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00		60.00				10.00		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												
S5617	272	0		29	10	S5617_272_0	2	Generic	4	010000	1	2	2	3		111	01		110	1				30	60	90	1	2				30		90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00		60.00				10.00		30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5617	272	0		29	10	S5617_272_0	2	Preferred Brand	4	000101	1	2	3	1		111	01		110	1				30	60	90	1	2				30		90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	272	0		29	10	S5617_272_0	2	Non-Preferred Drug	4	100100	1	1	4	1		111	01		110	1				30	60	90	1	2				30		90	30		31											51.62	50	50	50				43.13	50	50	50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	272	0		29	10	S5617_272_0	2	Specialty Tier	4	010010	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												
S5617	273	0		29	10	S5617_273_0	2	Preferred Generic	4	001000	1	2	1	1		111	01		110	1				30	60	90	1	2				30		90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00		45.00				5.00		15.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	273	0		29	10	S5617_273_0	2	Preferred Generic	4	001000	1	2	1	3		111	01		110	1				30	60	90	1	2				30		90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00		45.00				5.00		15.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5617	273	0		29	10	S5617_273_0	2	Generic	4	010000	1	2	2	1		111	01		110	1				30	60	90	1	2				30		90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00		60.00				10.00		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												
S5617	273	0		29	10	S5617_273_0	2	Generic	4	010000	1	2	2	3		111	01		110	1				30	60	90	1	2				30		90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00		60.00				10.00		30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5617	273	0		29	10	S5617_273_0	2	Preferred Brand	4	000101	1	2	3	1		111	01		110	1				30	60	90	1	2				30		90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	273	0		29	10	S5617_273_0	2	Non-Preferred Drug	4	100100	1	1	4	1		111	01		110	1				30	60	90	1	2				30		90	30		31											42.61	50	50	50				40.04	50	50	50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	273	0		29	10	S5617_273_0	2	Specialty Tier	4	010010	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												
S5617	274	0		29	10	S5617_274_0	2	Preferred Generic	4	001000	1	2	1	1		111	01		110	1				30	60	90	1	2				30		90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00		45.00				5.00		15.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	274	0		29	10	S5617_274_0	2	Preferred Generic	4	001000	1	2	1	3		111	01		110	1				30	60	90	1	2				30		90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00		45.00				5.00		15.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5617	274	0		29	10	S5617_274_0	2	Generic	4	010000	1	2	2	1		111	01		110	1				30	60	90	1	2				30		90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00		60.00				10.00		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												
S5617	274	0		29	10	S5617_274_0	2	Generic	4	010000	1	2	2	3		111	01		110	1				30	60	90	1	2				30		90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00		60.00				10.00		30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5617	274	0		29	10	S5617_274_0	2	Preferred Brand	4	000101	1	2	3	1		111	01		110	1				30	60	90	1	2				30		90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	274	0		29	10	S5617_274_0	2	Non-Preferred Drug	4	100100	1	1	4	1		111	01		110	1				30	60	90	1	2				30		90	30		31											47.29	50	50	50				42.36	50	50	50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	274	0		29	10	S5617_274_0	2	Specialty Tier	4	010010	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												
S5617	275	0		29	10	S5617_275_0	2	Preferred Generic	4	001000	1	2	1	1		111	01		110	1				30	60	90	1	2				30		90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00		45.00				5.00		15.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	275	0		29	10	S5617_275_0	2	Preferred Generic	4	001000	1	2	1	3		111	01		110	1				30	60	90	1	2				30		90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00		45.00				5.00		15.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5617	275	0		29	10	S5617_275_0	2	Generic	4	010000	1	2	2	1		111	01		110	1				30	60	90	1	2				30		90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00		60.00				10.00		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												
S5617	275	0		29	10	S5617_275_0	2	Generic	4	010000	1	2	2	3		111	01		110	1				30	60	90	1	2				30		90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00		60.00				10.00		30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5617	275	0		29	10	S5617_275_0	2	Preferred Brand	4	000101	1	2	3	1		111	01		110	1				30	60	90	1	2				30		90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	275	0		29	10	S5617_275_0	2	Non-Preferred Drug	4	100100	1	1	4	1		111	01		110	1				30	60	90	1	2				30		90	30		31											50.23	50	50	50				49.76	50	50	50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	275	0		29	10	S5617_275_0	2	Specialty Tier	4	010010	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												
S5617	276	0		29	10	S5617_276_0	2	Preferred Generic	4	001000	1	2	1	1		111	01		110	1				30	60	90	1	2				30		90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00		45.00				5.00		15.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	276	0		29	10	S5617_276_0	2	Preferred Generic	4	001000	1	2	1	3		111	01		110	1				30	60	90	1	2				30		90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00		45.00				5.00		15.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5617	276	0		29	10	S5617_276_0	2	Generic	4	010000	1	2	2	1		111	01		110	1				30	60	90	1	2				30		90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00		60.00				10.00		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												
S5617	276	0		29	10	S5617_276_0	2	Generic	4	010000	1	2	2	3		111	01		110	1				30	60	90	1	2				30		90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00		60.00				10.00		30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5617	276	0		29	10	S5617_276_0	2	Preferred Brand	4	000101	1	2	3	1		111	01		110	1				30	60	90	1	2				30		90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	276	0		29	10	S5617_276_0	2	Non-Preferred Drug	4	100100	1	1	4	1		111	01		110	1				30	60	90	1	2				30		90	30		31											45.57	50	50	50				44.87	50	50	50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	276	0		29	10	S5617_276_0	2	Specialty Tier	4	010010	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												
S5617	277	0		29	10	S5617_277_0	2	Preferred Generic	4	001000	1	2	1	1		111	01		110	1				30	60	90	1	2				30		90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00		45.00				5.00		15.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	277	0		29	10	S5617_277_0	2	Preferred Generic	4	001000	1	2	1	3		111	01		110	1				30	60	90	1	2				30		90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00		45.00				5.00		15.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5617	277	0		29	10	S5617_277_0	2	Generic	4	010000	1	2	2	1		111	01		110	1				30	60	90	1	2				30		90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00		60.00				10.00		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												
S5617	277	0		29	10	S5617_277_0	2	Generic	4	010000	1	2	2	3		111	01		110	1				30	60	90	1	2				30		90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00		60.00				10.00		30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5617	277	0		29	10	S5617_277_0	2	Preferred Brand	4	000101	1	2	3	1		111	01		110	1				30	60	90	1	2				30		90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	277	0		29	10	S5617_277_0	2	Non-Preferred Drug	4	100100	1	1	4	1		111	01		110	1				30	60	90	1	2				30		90	30		31											56.58	50	50	50				49.63	50	50	50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	277	0		29	10	S5617_277_0	2	Specialty Tier	4	010010	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												
S5617	278	0		29	10	S5617_278_0	2	Preferred Generic	4	001000	1	2	1	1		111	01		110	1				30	60	90	1	2				30		90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00		45.00				5.00		15.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	278	0		29	10	S5617_278_0	2	Preferred Generic	4	001000	1	2	1	3		111	01		110	1				30	60	90	1	2				30		90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00		45.00				5.00		15.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5617	278	0		29	10	S5617_278_0	2	Generic	4	010000	1	2	2	1		111	01		110	1				30	60	90	1	2				30		90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00		60.00				10.00		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												
S5617	278	0		29	10	S5617_278_0	2	Generic	4	010000	1	2	2	3		111	01		110	1				30	60	90	1	2				30		90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00		60.00				10.00		30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5617	278	0		29	10	S5617_278_0	2	Preferred Brand	4	000101	1	2	3	1		111	01		110	1				30	60	90	1	2				30		90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	278	0		29	10	S5617_278_0	2	Non-Preferred Drug	4	100100	1	1	4	1		111	01		110	1				30	60	90	1	2				30		90	30		31											61.12	50	50	50				50.04	50	50	50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	278	0		29	10	S5617_278_0	2	Specialty Tier	4	010010	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												
S5617	279	0		29	10	S5617_279_0	2	Preferred Generic	4	001000	1	2	1	1		111	01		110	1				30	60	90	1	2				30		90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00		45.00				5.00		15.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	279	0		29	10	S5617_279_0	2	Preferred Generic	4	001000	1	2	1	3		111	01		110	1				30	60	90	1	2				30		90	30		31								15.00	30.00	45.00					5.00	10.00	15.00											15.00		45.00				5.00		15.00				15.00				15.00			0.50	0.17		0.50	0.17	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5617	279	0		29	10	S5617_279_0	2	Generic	4	010000	1	2	2	1		111	01		110	1				30	60	90	1	2				30		90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00		60.00				10.00		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												
S5617	279	0		29	10	S5617_279_0	2	Generic	4	010000	1	2	2	3		111	01		110	1				30	60	90	1	2				30		90	30		31								20.00	40.00	60.00					10.00	20.00	30.00											20.00		60.00				10.00		30.00				20.00				20.00			0.67	0.33		0.67	0.33	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5617	279	0		29	10	S5617_279_0	2	Preferred Brand	4	000101	1	2	3	1		111	01		110	1				30	60	90	1	2				30		90	30		31								47.00	94.00	141.00					42.00	84.00	126.00											47.00		141.00				42.00		126.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	279	0		29	10	S5617_279_0	2	Non-Preferred Drug	4	100100	1	1	4	1		111	01		110	1				30	60	90	1	2				30		90	30		31											46.56	50	50	50				42.93	50	50	50										50		50				50		50			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5617	279	0		29	10	S5617_279_0	2	Specialty Tier	4	010010	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												
S5660	104	0		29	10	S5660_104_0	1	Preferred Generic	2	001010	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													8.00						3.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	104	0		29	10	S5660_104_0	1	Generic	2	010010	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					3.00		9.00													11.00						6.00				10.00				10.00			0.32	0.10				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	104	0		29	10	S5660_104_0	1	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								42.00		126.00					37.00		111.00													116.00						111.00				42.00				42.00			1.35	1.19				1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	104	0		29	10	S5660_104_0	1	Non-Preferred Drug	2	100100	1	1	4	1		010	01		010	1				31								31			31		31											40.16	50						35.24	48												50						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	104	0		29	10	S5660_104_0	1	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	105	0		29	10	S5660_105_0	1	Preferred Generic	2	001010	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													8.00						3.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	105	0		29	10	S5660_105_0	1	Generic	2	010010	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					3.00		9.00													11.00						6.00				10.00				10.00			0.32	0.10				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	105	0		29	10	S5660_105_0	1	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								41.00		123.00					36.00		108.00													113.00						108.00				41.00				41.00			1.32	1.16				1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	105	0		29	10	S5660_105_0	1	Non-Preferred Drug	2	100100	1	1	4	1		010	01		010	1				31								31			31		31											58.84	50						53.66	48												50						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	105	0		29	10	S5660_105_0	1	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	106	0		29	10	S5660_106_0	1	Preferred Generic	2	001010	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													8.00						3.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	106	0		29	10	S5660_106_0	1	Generic	2	010010	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					3.00		9.00													11.00						6.00				10.00				10.00			0.32	0.10				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	106	0		29	10	S5660_106_0	1	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								41.00		123.00					36.00		108.00													113.00						108.00				41.00				41.00			1.32	1.16				1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	106	0		29	10	S5660_106_0	1	Non-Preferred Drug	2	100100	1	1	4	1		010	01		010	1				31								31			31		31											57.83	50						55.18	48												50						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	106	0		29	10	S5660_106_0	1	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	107	0		29	10	S5660_107_0	1	Preferred Generic	2	001010	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													8.00						3.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	107	0		29	10	S5660_107_0	1	Generic	2	010010	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					3.00		9.00													11.00						6.00				10.00				10.00			0.32	0.10				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	107	0		29	10	S5660_107_0	1	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								43.00		129.00					38.00		114.00													119.00						114.00				43.00				43.00			1.39	1.23				1.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	107	0		29	10	S5660_107_0	1	Non-Preferred Drug	2	100100	1	1	4	1		010	01		010	1				31								31			31		31											56.38	50						53.30	48												50						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	107	0		29	10	S5660_107_0	1	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	108	0		29	10	S5660_108_0	1	Preferred Generic	2	001010	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													8.00						3.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	108	0		29	10	S5660_108_0	1	Generic	2	010010	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					3.00		9.00													11.00						6.00				10.00				10.00			0.32	0.10				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	108	0		29	10	S5660_108_0	1	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								36.00		108.00					31.00		93.00													98.00						93.00				36.00				36.00			1.16	1.00				1.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	108	0		29	10	S5660_108_0	1	Non-Preferred Drug	2	100100	1	1	4	1		010	01		010	1				31								31			31		31											57.18	50						54.61	48												50						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	108	0		29	10	S5660_108_0	1	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	109	0		29	10	S5660_109_0	1	Preferred Generic	2	001010	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													8.00						3.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	109	0		29	10	S5660_109_0	1	Generic	2	010010	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					3.00		9.00													11.00						6.00				10.00				10.00			0.32	0.10				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	109	0		29	10	S5660_109_0	1	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								44.00		132.00					39.00		117.00													122.00						117.00				44.00				44.00			1.42	1.26				1.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	109	0		29	10	S5660_109_0	1	Non-Preferred Drug	2	100100	1	1	4	1		010	01		010	1				31								31			31		31											49.66	50						45.89	48												50						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	109	0		29	10	S5660_109_0	1	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	110	0		29	10	S5660_110_0	1	Preferred Generic	2	001010	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								6.00		18.00					0.00		0.00													8.00						3.00				6.00				6.00			0.19	0.00				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	110	0		29	10	S5660_110_0	1	Generic	2	010010	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								11.00		33.00					3.00		9.00													11.00						6.00				11.00				11.00			0.35	0.10				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	110	0		29	10	S5660_110_0	1	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													131.00						126.00				47.00				47.00			1.52	1.35				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	110	0		29	10	S5660_110_0	1	Non-Preferred Drug	2	100100	1	1	4	1		010	01		010	1				31								31			31		31											55.02	50						52.18	48												50						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	110	0		29	10	S5660_110_0	1	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	111	0		29	10	S5660_111_0	1	Preferred Generic	2	001010	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													8.00						3.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	111	0		29	10	S5660_111_0	1	Generic	2	010010	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					3.00		9.00													11.00						6.00				10.00				10.00			0.32	0.10				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	111	0		29	10	S5660_111_0	1	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								45.00		135.00					40.00		120.00													125.00						120.00				45.00				45.00			1.45	1.29				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	111	0		29	10	S5660_111_0	1	Non-Preferred Drug	2	100100	1	1	4	1		010	01		010	1				31								31			31		31											53.22	50						47.20	48												50						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	111	0		29	10	S5660_111_0	1	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	112	0		29	10	S5660_112_0	1	Preferred Generic	2	001010	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								7.00		21.00					0.00		0.00													8.00						3.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	112	0		29	10	S5660_112_0	1	Generic	2	010010	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								12.00		36.00					3.00		9.00													11.00						6.00				12.00				12.00			0.39	0.10				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	112	0		29	10	S5660_112_0	1	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													131.00						126.00				47.00				47.00			1.52	1.35				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	112	0		29	10	S5660_112_0	1	Non-Preferred Drug	2	100100	1	1	4	1		010	01		010	1				31								31			31		31											47.04	50						42.68	48												50						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	112	0		29	10	S5660_112_0	1	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	113	0		29	10	S5660_113_0	1	Preferred Generic	2	001010	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													8.00						3.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	113	0		29	10	S5660_113_0	1	Generic	2	010010	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					3.00		9.00													11.00						6.00				10.00				10.00			0.32	0.10				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	113	0		29	10	S5660_113_0	1	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								45.00		135.00					40.00		120.00													125.00						120.00				45.00				45.00			1.45	1.29				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	113	0		29	10	S5660_113_0	1	Non-Preferred Drug	2	100100	1	1	4	1		010	01		010	1				31								31			31		31											57.46	50						55.70	48												50						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	113	0		29	10	S5660_113_0	1	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	114	0		29	10	S5660_114_0	1	Preferred Generic	2	001010	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													8.00						3.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	114	0		29	10	S5660_114_0	1	Generic	2	010010	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					3.00		9.00													11.00						6.00				10.00				10.00			0.32	0.10				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	114	0		29	10	S5660_114_0	1	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								46.00		138.00					41.00		123.00													128.00						123.00				46.00				46.00			1.48	1.32				1.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	114	0		29	10	S5660_114_0	1	Non-Preferred Drug	2	100100	1	1	4	1		010	01		010	1				31								31			31		31											53.21	50						49.91	48												50						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	114	0		29	10	S5660_114_0	1	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	115	0		29	10	S5660_115_0	1	Preferred Generic	2	001010	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													8.00						3.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	115	0		29	10	S5660_115_0	1	Generic	2	010010	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					3.00		9.00													11.00						6.00				10.00				10.00			0.32	0.10				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	115	0		29	10	S5660_115_0	1	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								45.00		135.00					40.00		120.00													125.00						120.00				45.00				45.00			1.45	1.29				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	115	0		29	10	S5660_115_0	1	Non-Preferred Drug	2	100100	1	1	4	1		010	01		010	1				31								31			31		31											56.07	50						54.33	48												50						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	115	0		29	10	S5660_115_0	1	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	116	0		29	10	S5660_116_0	1	Preferred Generic	2	001010	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													8.00						3.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	116	0		29	10	S5660_116_0	1	Generic	2	010010	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					3.00		9.00													11.00						6.00				10.00				10.00			0.32	0.10				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	116	0		29	10	S5660_116_0	1	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													131.00						126.00				47.00				47.00			1.52	1.35				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	116	0		29	10	S5660_116_0	1	Non-Preferred Drug	2	100100	1	1	4	1		010	01		010	1				31								31			31		31											32.85	50						30.66	48												50						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	116	0		29	10	S5660_116_0	1	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	117	0		29	10	S5660_117_0	1	Preferred Generic	2	001010	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													8.00						3.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	117	0		29	10	S5660_117_0	1	Generic	2	010010	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					3.00		9.00													11.00						6.00				10.00				10.00			0.32	0.10				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	117	0		29	10	S5660_117_0	1	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								41.00		123.00					36.00		108.00													113.00						108.00				41.00				41.00			1.32	1.16				1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	117	0		29	10	S5660_117_0	1	Non-Preferred Drug	2	100100	1	1	4	1		010	01		010	1				31								31			31		31											54.90	50						51.86	48												50						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	117	0		29	10	S5660_117_0	1	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	118	0		29	10	S5660_118_0	1	Preferred Generic	2	001010	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					0.00		0.00													8.00						3.00				10.00				10.00			0.32	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	118	0		29	10	S5660_118_0	1	Generic	2	010010	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								16.00		48.00					3.00		9.00													11.00						6.00				16.00				16.00			0.52	0.10				0.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	118	0		29	10	S5660_118_0	1	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													131.00						126.00				47.00				47.00			1.52	1.35				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	118	0		29	10	S5660_118_0	1	Non-Preferred Drug	2	100100	1	1	4	1		010	01		010	1				31								31			31		31											53.82	50						49.21	48												50						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	118	0		29	10	S5660_118_0	1	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	119	0		29	10	S5660_119_0	1	Preferred Generic	2	001010	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					0.00		0.00													8.00						3.00				10.00				10.00			0.32	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	119	0		29	10	S5660_119_0	1	Generic	2	010010	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					4.00		12.00													13.00						8.00				20.00				20.00			0.65	0.13				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	119	0		29	10	S5660_119_0	1	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													131.00						126.00				47.00				47.00			1.52	1.35				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	119	0		29	10	S5660_119_0	1	Non-Preferred Drug	2	100100	1	1	4	1		010	01		010	1				31								31			31		31											51.27	50						46.92	48												50						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	119	0		29	10	S5660_119_0	1	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	120	0		29	10	S5660_120_0	1	Preferred Generic	2	001010	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					0.00		0.00													8.00						3.00				10.00				10.00			0.32	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	120	0		29	10	S5660_120_0	1	Generic	2	010010	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								15.00		45.00					3.00		9.00													11.00						6.00				15.00				15.00			0.48	0.10				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	120	0		29	10	S5660_120_0	1	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													131.00						126.00				47.00				47.00			1.52	1.35				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	120	0		29	10	S5660_120_0	1	Non-Preferred Drug	2	100100	1	1	4	1		010	01		010	1				31								31			31		31											54.72	50						53.26	48												50						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	120	0		29	10	S5660_120_0	1	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	121	0		29	10	S5660_121_0	1	Preferred Generic	2	001010	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					0.00		0.00													8.00						3.00				10.00				10.00			0.32	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	121	0		29	10	S5660_121_0	1	Generic	2	010010	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								18.00		54.00					3.00		9.00													11.00						6.00				18.00				18.00			0.58	0.10				0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	121	0		29	10	S5660_121_0	1	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													131.00						126.00				47.00				47.00			1.52	1.35				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	121	0		29	10	S5660_121_0	1	Non-Preferred Drug	2	100100	1	1	4	1		010	01		010	1				31								31			31		31											54.22	50						48.65	48												50						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	121	0		29	10	S5660_121_0	1	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	122	0		29	10	S5660_122_0	1	Preferred Generic	2	001010	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					0.00		0.00													8.00						3.00				10.00				10.00			0.32	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	122	0		29	10	S5660_122_0	1	Generic	2	010010	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					4.00		12.00													13.00						8.00				20.00				20.00			0.65	0.13				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	122	0		29	10	S5660_122_0	1	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													131.00						126.00				47.00				47.00			1.52	1.35				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	122	0		29	10	S5660_122_0	1	Non-Preferred Drug	2	100100	1	1	4	1		010	01		010	1				31								31			31		31											47.22	50						42.42	48												50						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	122	0		29	10	S5660_122_0	1	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	123	0		29	10	S5660_123_0	1	Preferred Generic	2	001010	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													8.00						3.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	123	0		29	10	S5660_123_0	1	Generic	2	010010	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					3.00		9.00													11.00						6.00				10.00				10.00			0.32	0.10				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	123	0		29	10	S5660_123_0	1	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								46.00		138.00					41.00		123.00													128.00						123.00				46.00				46.00			1.48	1.32				1.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	123	0		29	10	S5660_123_0	1	Non-Preferred Drug	2	100100	1	1	4	1		010	01		010	1				31								31			31		31											53.86	50						50.87	48												50						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	123	0		29	10	S5660_123_0	1	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	124	0		29	10	S5660_124_0	1	Preferred Generic	2	001010	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					0.00		0.00													8.00						3.00				10.00				10.00			0.32	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	124	0		29	10	S5660_124_0	1	Generic	2	010010	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					3.00		9.00													11.00						6.00				20.00				20.00			0.65	0.10				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	124	0		29	10	S5660_124_0	1	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													131.00						126.00				47.00				47.00			1.52	1.35				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	124	0		29	10	S5660_124_0	1	Non-Preferred Drug	2	100100	1	1	4	1		010	01		010	1				31								31			31		31											42.32	50						39.63	48												50						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	124	0		29	10	S5660_124_0	1	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	125	0		29	10	S5660_125_0	1	Preferred Generic	2	001010	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								7.00		21.00					0.00		0.00													8.00						3.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	125	0		29	10	S5660_125_0	1	Generic	2	010010	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								12.00		36.00					3.00		9.00													11.00						6.00				12.00				12.00			0.39	0.10				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	125	0		29	10	S5660_125_0	1	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													131.00						126.00				47.00				47.00			1.52	1.35				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	125	0		29	10	S5660_125_0	1	Non-Preferred Drug	2	100100	1	1	4	1		010	01		010	1				31								31			31		31											58.06	50						52.48	48												50						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	125	0		29	10	S5660_125_0	1	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	126	0		29	10	S5660_126_0	1	Preferred Generic	2	001010	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													8.00						3.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	126	0		29	10	S5660_126_0	1	Generic	2	010010	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					3.00		9.00													11.00						6.00				10.00				10.00			0.32	0.10				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	126	0		29	10	S5660_126_0	1	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													131.00						126.00				47.00				47.00			1.52	1.35				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	126	0		29	10	S5660_126_0	1	Non-Preferred Drug	2	100100	1	1	4	1		010	01		010	1				31								31			31		31											46.00	50						42.00	48												50						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	126	0		29	10	S5660_126_0	1	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	127	0		29	10	S5660_127_0	1	Preferred Generic	2	001010	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													8.00						3.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	127	0		29	10	S5660_127_0	1	Generic	2	010010	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					3.00		9.00													11.00						6.00				10.00				10.00			0.32	0.10				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	127	0		29	10	S5660_127_0	1	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								45.00		135.00					40.00		120.00													125.00						120.00				45.00				45.00			1.45	1.29				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	127	0		29	10	S5660_127_0	1	Non-Preferred Drug	2	100100	1	1	4	1		010	01		010	1				31								31			31		31											43.82	50						38.76	48												50						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	127	0		29	10	S5660_127_0	1	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	128	0		29	10	S5660_128_0	1	Preferred Generic	2	001010	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					0.00		0.00													8.00						3.00				10.00				10.00			0.32	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	128	0		29	10	S5660_128_0	1	Generic	2	010010	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					5.00		15.00													15.00						10.00				20.00				20.00			0.65	0.16				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	128	0		29	10	S5660_128_0	1	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													131.00						126.00				47.00				47.00			1.52	1.35				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	128	0		29	10	S5660_128_0	1	Non-Preferred Drug	2	100100	1	1	4	1		010	01		010	1				31								31			31		31											41.46	50						41.16	48												50						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	128	0		29	10	S5660_128_0	1	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	129	0		29	10	S5660_129_0	1	Preferred Generic	2	001010	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													8.00						3.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	129	0		29	10	S5660_129_0	1	Generic	2	010010	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					3.00		9.00													11.00						6.00				10.00				10.00			0.32	0.10				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	129	0		29	10	S5660_129_0	1	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								43.00		129.00					38.00		114.00													119.00						114.00				43.00				43.00			1.39	1.23				1.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	129	0		29	10	S5660_129_0	1	Non-Preferred Drug	2	100100	1	1	4	1		010	01		010	1				31								31			31		31											54.59	50						50.40	48												50						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	129	0		29	10	S5660_129_0	1	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	130	0		29	10	S5660_130_0	1	Preferred Generic	2	001010	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													8.00						3.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	130	0		29	10	S5660_130_0	1	Generic	2	010010	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					3.00		9.00													11.00						6.00				10.00				10.00			0.32	0.10				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	130	0		29	10	S5660_130_0	1	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								46.00		138.00					41.00		123.00													128.00						123.00				46.00				46.00			1.48	1.32				1.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	130	0		29	10	S5660_130_0	1	Non-Preferred Drug	2	100100	1	1	4	1		010	01		010	1				31								31			31		31											52.22	50						45.87	48												50						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	130	0		29	10	S5660_130_0	1	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	131	0		29	10	S5660_131_0	1	Preferred Generic	2	001010	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													8.00						3.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	131	0		29	10	S5660_131_0	1	Generic	2	010010	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					3.00		9.00													11.00						6.00				10.00				10.00			0.32	0.10				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	131	0		29	10	S5660_131_0	1	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								46.00		138.00					41.00		123.00													128.00						123.00				46.00				46.00			1.48	1.32				1.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	131	0		29	10	S5660_131_0	1	Non-Preferred Drug	2	100100	1	1	4	1		010	01		010	1				31								31			31		31											55.85	50						46.39	48												50						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	131	0		29	10	S5660_131_0	1	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	132	0		29	10	S5660_132_0	1	Preferred Generic	2	001010	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													8.00						3.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	132	0		29	10	S5660_132_0	1	Generic	2	010010	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					3.00		9.00													11.00						6.00				10.00				10.00			0.32	0.10				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	132	0		29	10	S5660_132_0	1	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								42.00		126.00					37.00		111.00													116.00						111.00				42.00				42.00			1.35	1.19				1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	132	0		29	10	S5660_132_0	1	Non-Preferred Drug	2	100100	1	1	4	1		010	01		010	1				31								31			31		31											50.46	50						45.80	48												50						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	132	0		29	10	S5660_132_0	1	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	133	0		29	10	S5660_133_0	1	Preferred Generic	2	001010	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													8.00						3.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	133	0		29	10	S5660_133_0	1	Generic	2	010010	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					3.00		9.00													11.00						6.00				10.00				10.00			0.32	0.10				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	133	0		29	10	S5660_133_0	1	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								39.00		117.00					34.00		102.00													107.00						102.00				39.00				39.00			1.26	1.10				1.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	133	0		29	10	S5660_133_0	1	Non-Preferred Drug	2	100100	1	1	4	1		010	01		010	1				31								31			31		31											56.63	50						53.15	48												50						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	133	0		29	10	S5660_133_0	1	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	134	0		29	10	S5660_134_0	1	Preferred Generic	2	001010	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								7.00		21.00					0.00		0.00													8.00						3.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	134	0		29	10	S5660_134_0	1	Generic	2	010010	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								12.00		36.00					3.00		9.00													11.00						6.00				12.00				12.00			0.39	0.10				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	134	0		29	10	S5660_134_0	1	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													131.00						126.00				47.00				47.00			1.52	1.35				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	134	0		29	10	S5660_134_0	1	Non-Preferred Drug	2	100100	1	1	4	1		010	01		010	1				31								31			31		31											41.08	50						45.07	48												50						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	134	0		29	10	S5660_134_0	1	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	135	0		29	10	S5660_135_0	1	Preferred Generic	2	001010	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								7.00		21.00					0.00		0.00													8.00						3.00				7.00				7.00			0.23	0.00				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	135	0		29	10	S5660_135_0	1	Generic	2	010010	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								12.00		36.00					3.00		9.00													11.00						6.00				12.00				12.00			0.39	0.10				0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	135	0		29	10	S5660_135_0	1	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													131.00						126.00				47.00				47.00			1.52	1.35				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	135	0		29	10	S5660_135_0	1	Non-Preferred Drug	2	100100	1	1	4	1		010	01		010	1				31								31			31		31											56.45	50						45.22	48												50						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	135	0		29	10	S5660_135_0	1	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	136	0		29	10	S5660_136_0	1	Preferred Generic	2	001010	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													8.00						3.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	136	0		29	10	S5660_136_0	1	Generic	2	010010	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					3.00		9.00													11.00						6.00				10.00				10.00			0.32	0.10				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	136	0		29	10	S5660_136_0	1	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								40.00		120.00					35.00		105.00													110.00						105.00				40.00				40.00			1.29	1.13				1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	136	0		29	10	S5660_136_0	1	Non-Preferred Drug	2	100100	1	1	4	1		010	01		010	1				31								31			31		31											50.65	50						44.79	48												50						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	136	0		29	10	S5660_136_0	1	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	137	0		29	10	S5660_137_0	1	Preferred Generic	2	001010	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					0.00		0.00													8.00						3.00				10.00				10.00			0.32	0.00				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	137	0		29	10	S5660_137_0	1	Generic	2	010010	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					5.00		15.00													15.00						10.00				20.00				20.00			0.65	0.16				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	137	0		29	10	S5660_137_0	1	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								47.00		141.00					42.00		126.00													131.00						126.00				47.00				47.00			1.52	1.35				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	137	0		29	10	S5660_137_0	1	Non-Preferred Drug	2	100100	1	1	4	1		010	01		010	1				31								31			31		31											43.29	50						36.37	48												50						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	137	0		29	10	S5660_137_0	1	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	172	0		29	10	S5660_172_0	1	Preferred Generic	4	001010	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					2.00		6.00													5.00						0.00				10.00				10.00			0.32	0.06				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	172	0		29	10	S5660_172_0	1	Generic	4	010010	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					7.00		21.00													9.00						4.00				20.00				20.00			0.65	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	172	0		29	10	S5660_172_0	1	Preferred Brand	4	010001	1	1	3	1		110	01		100	1				31		90	1	2						90	31		31											59.16	23		23				54.19	21		21												23						23			23			23								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	172	0		29	10	S5660_172_0	1	Non-Preferred Drug	4	100100	1	1	4	1		010	01		010	1				31								31			31		31											62.45	50						57.68	48												50						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	172	0		29	10	S5660_172_0	1	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				31								31			31		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	176	0		29	10	S5660_176_0	1	Preferred Generic	4	001010	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					2.00		6.00													5.00						0.00				10.00				10.00			0.32	0.06				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	176	0		29	10	S5660_176_0	1	Generic	4	010010	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					7.00		21.00													9.00						4.00				20.00				20.00			0.65	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	176	0		29	10	S5660_176_0	1	Preferred Brand	4	010001	1	1	3	1		110	01		100	1				31		90	1	2						90	31		31											60.05	25		25				55.35	23		23												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	176	0		29	10	S5660_176_0	1	Non-Preferred Drug	4	100100	1	1	4	1		010	01		010	1				31								31			31		31											65.95	50						63.94	48												50						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	176	0		29	10	S5660_176_0	1	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				31								31			31		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	180	0		29	10	S5660_180_0	1	Preferred Generic	4	001010	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					2.00		6.00													5.00						0.00				10.00				10.00			0.32	0.06				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	180	0		29	10	S5660_180_0	1	Generic	4	010010	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					7.00		21.00													9.00						4.00				20.00				20.00			0.65	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	180	0		29	10	S5660_180_0	1	Preferred Brand	4	010001	1	1	3	1		110	01		100	1				31		90	1	2						90	31		31											57.52	25		25				53.43	23		23												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	180	0		29	10	S5660_180_0	1	Non-Preferred Drug	4	100100	1	1	4	1		010	01		010	1				31								31			31		31											52.78	50						50.47	48												50						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	180	0		29	10	S5660_180_0	1	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				31								31			31		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	181	0		29	10	S5660_181_0	1	Preferred Generic	4	001010	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					2.00		6.00													5.00						0.00				10.00				10.00			0.32	0.06				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	181	0		29	10	S5660_181_0	1	Generic	4	010010	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					7.00		21.00													9.00						4.00				20.00				20.00			0.65	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	181	0		29	10	S5660_181_0	1	Preferred Brand	4	010001	1	1	3	1		110	01		100	1				31		90	1	2						90	31		31											58.96	25		25				54.20	23		23												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	181	0		29	10	S5660_181_0	1	Non-Preferred Drug	4	100100	1	1	4	1		010	01		010	1				31								31			31		31											55.92	50						53.40	48												50						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	181	0		29	10	S5660_181_0	1	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				31								31			31		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	182	0		29	10	S5660_182_0	1	Preferred Generic	4	001010	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					2.00		6.00													5.00						0.00				10.00				10.00			0.32	0.06				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	182	0		29	10	S5660_182_0	1	Generic	4	010010	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					7.00		21.00													9.00						4.00				20.00				20.00			0.65	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	182	0		29	10	S5660_182_0	1	Preferred Brand	4	010001	1	1	3	1		110	01		100	1				31		90	1	2						90	31		31											57.72	25		25				53.06	23		23												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	182	0		29	10	S5660_182_0	1	Non-Preferred Drug	4	100100	1	1	4	1		010	01		010	1				31								31			31		31											80.39	50						72.48	48												50						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	182	0		29	10	S5660_182_0	1	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				31								31			31		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	183	0		29	10	S5660_183_0	2	Preferred Generic	4	001010	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					2.00		6.00													5.00						0.00				10.00				10.00			0.32	0.06				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	183	0		29	10	S5660_183_0	2	Generic	4	010010	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					7.00		21.00													9.00						4.00				20.00				20.00			0.65	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	183	0		29	10	S5660_183_0	2	Preferred Brand	4	010001	1	1	3	1		110	01		100	1				31		90	1	2						90	31		31											57.08	25		25				52.50	23		23												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	183	0		29	10	S5660_183_0	2	Non-Preferred Drug	4	100100	1	1	4	1		010	01		010	1				31								31			31		31											86.73	50						83.23	48												50						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	183	0		29	10	S5660_183_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				31								31			31		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	184	0		29	10	S5660_184_0	1	Preferred Generic	4	001010	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					2.00		6.00													5.00						0.00				10.00				10.00			0.32	0.06				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	184	0		29	10	S5660_184_0	1	Generic	4	010010	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					7.00		21.00													9.00						4.00				20.00				20.00			0.65	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	184	0		29	10	S5660_184_0	1	Preferred Brand	4	010001	1	1	3	1		110	01		100	1				31		90	1	2						90	31		31											60.17	25		25				55.05	23		23												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	184	0		29	10	S5660_184_0	1	Non-Preferred Drug	4	100100	1	1	4	1		010	01		010	1				31								31			31		31											63.03	50						58.87	48												50						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	184	0		29	10	S5660_184_0	1	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				31								31			31		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	185	0		29	10	S5660_185_0	1	Preferred Generic	4	001010	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					2.00		6.00													5.00						0.00				10.00				10.00			0.32	0.06				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	185	0		29	10	S5660_185_0	1	Generic	4	010010	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					7.00		21.00													9.00						4.00				20.00				20.00			0.65	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	185	0		29	10	S5660_185_0	1	Preferred Brand	4	010001	1	1	3	1		110	01		100	1				31		90	1	2						90	31		31											56.22	25		25				51.90	23		23												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	185	0		29	10	S5660_185_0	1	Non-Preferred Drug	4	100100	1	1	4	1		010	01		010	1				31								31			31		31											71.43	50						64.06	48												50						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	185	0		29	10	S5660_185_0	1	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				31								31			31		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	186	0		29	10	S5660_186_0	1	Preferred Generic	4	001010	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					2.00		6.00													5.00						0.00				10.00				10.00			0.32	0.06				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	186	0		29	10	S5660_186_0	1	Generic	4	010010	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					7.00		21.00													9.00						4.00				20.00				20.00			0.65	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	186	0		29	10	S5660_186_0	1	Preferred Brand	4	010001	1	1	3	1		110	01		100	1				31		90	1	2						90	31		31											59.50	25		25				55.10	23		23												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	186	0		29	10	S5660_186_0	1	Non-Preferred Drug	4	100100	1	1	4	1		010	01		010	1				31								31			31		31											96.30	50						90.49	48												50						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	186	0		29	10	S5660_186_0	1	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				31								31			31		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	187	0		29	10	S5660_187_0	1	Preferred Generic	4	001010	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					2.00		6.00													5.00						0.00				10.00				10.00			0.32	0.06				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	187	0		29	10	S5660_187_0	1	Generic	4	010010	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					7.00		21.00													9.00						4.00				20.00				20.00			0.65	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	187	0		29	10	S5660_187_0	1	Preferred Brand	4	010001	1	1	3	1		110	01		100	1				31		90	1	2						90	31		31											54.50	25		25				50.52	23		23												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	187	0		29	10	S5660_187_0	1	Non-Preferred Drug	4	100100	1	1	4	1		010	01		010	1				31								31			31		31											71.78	50						65.56	48												50						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	187	0		29	10	S5660_187_0	1	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				31								31			31		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	190	0		29	10	S5660_190_0	1	Preferred Generic	4	001010	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					2.00		6.00													5.00						0.00				10.00				10.00			0.32	0.06				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	190	0		29	10	S5660_190_0	1	Generic	4	010010	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					7.00		21.00													9.00						4.00				20.00				20.00			0.65	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	190	0		29	10	S5660_190_0	1	Preferred Brand	4	010001	1	1	3	1		110	01		100	1				31		90	1	2						90	31		31											60.65	25		25				54.86	23		23												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	190	0		29	10	S5660_190_0	1	Non-Preferred Drug	4	100100	1	1	4	1		010	01		010	1				31								31			31		31											65.67	50						62.59	48												50						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	190	0		29	10	S5660_190_0	1	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				31								31			31		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	192	0		29	10	S5660_192_0	1	Preferred Generic	4	001010	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					2.00		6.00													5.00						0.00				10.00				10.00			0.32	0.06				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	192	0		29	10	S5660_192_0	1	Generic	4	010010	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					7.00		21.00													9.00						4.00				20.00				20.00			0.65	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	192	0		29	10	S5660_192_0	1	Preferred Brand	4	010001	1	1	3	1		110	01		100	1				31		90	1	2						90	31		31											60.95	25		25				56.12	23		23												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	192	0		29	10	S5660_192_0	1	Non-Preferred Drug	4	100100	1	1	4	1		010	01		010	1				31								31			31		31											62.80	50						60.22	48												50						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	192	0		29	10	S5660_192_0	1	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				31								31			31		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	194	0		29	10	S5660_194_0	1	Preferred Generic	4	001010	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					2.00		6.00													5.00						0.00				10.00				10.00			0.32	0.06				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	194	0		29	10	S5660_194_0	1	Generic	4	010010	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					7.00		21.00													9.00						4.00				20.00				20.00			0.65	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	194	0		29	10	S5660_194_0	1	Preferred Brand	4	010001	1	1	3	1		110	01		100	1				31		90	1	2						90	31		31											60.74	25		25				55.92	23		23												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	194	0		29	10	S5660_194_0	1	Non-Preferred Drug	4	100100	1	1	4	1		010	01		010	1				31								31			31		31											64.22	50						60.27	48												50						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	194	0		29	10	S5660_194_0	1	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				31								31			31		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	195	0		29	10	S5660_195_0	1	Preferred Generic	4	001010	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					2.00		6.00													5.00						0.00				10.00				10.00			0.32	0.06				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	195	0		29	10	S5660_195_0	1	Generic	4	010010	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					7.00		21.00													9.00						4.00				20.00				20.00			0.65	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	195	0		29	10	S5660_195_0	1	Preferred Brand	4	010001	1	1	3	1		110	01		100	1				31		90	1	2						90	31		31											57.99	25		25				53.63	23		23												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	195	0		29	10	S5660_195_0	1	Non-Preferred Drug	4	100100	1	1	4	1		010	01		010	1				31								31			31		31											53.55	50						51.03	48												50						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	195	0		29	10	S5660_195_0	1	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				31								31			31		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	196	0		29	10	S5660_196_0	1	Preferred Generic	4	001010	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					2.00		6.00													5.00						0.00				10.00				10.00			0.32	0.06				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	196	0		29	10	S5660_196_0	1	Generic	4	010010	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					7.00		21.00													9.00						4.00				20.00				20.00			0.65	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	196	0		29	10	S5660_196_0	1	Preferred Brand	4	010001	1	1	3	1		110	01		100	1				31		90	1	2						90	31		31											60.39	25		25				54.10	23		23												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	196	0		29	10	S5660_196_0	1	Non-Preferred Drug	4	100100	1	1	4	1		010	01		010	1				31								31			31		31											64.24	50						56.39	48												50						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	196	0		29	10	S5660_196_0	1	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				31								31			31		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	197	0		29	10	S5660_197_0	1	Preferred Generic	4	001010	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					2.00		6.00													5.00						0.00				10.00				10.00			0.32	0.06				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	197	0		29	10	S5660_197_0	1	Generic	4	010010	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					7.00		21.00													9.00						4.00				20.00				20.00			0.65	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	197	0		29	10	S5660_197_0	1	Preferred Brand	4	010001	1	1	3	1		110	01		100	1				31		90	1	2						90	31		31											57.71	24		24				52.89	22		22												24						24			24			24								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	197	0		29	10	S5660_197_0	1	Non-Preferred Drug	4	100100	1	1	4	1		010	01		010	1				31								31			31		31											79.94	50						76.31	48												50						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	197	0		29	10	S5660_197_0	1	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				31								31			31		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	198	0		29	10	S5660_198_0	1	Preferred Generic	4	001010	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					2.00		6.00													5.00						0.00				10.00				10.00			0.32	0.06				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	198	0		29	10	S5660_198_0	1	Generic	4	010010	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					7.00		21.00													9.00						4.00				20.00				20.00			0.65	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	198	0		29	10	S5660_198_0	1	Preferred Brand	4	010001	1	1	3	1		110	01		100	1				31		90	1	2						90	31		31											56.17	25		25				51.07	23		23												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	198	0		29	10	S5660_198_0	1	Non-Preferred Drug	4	100100	1	1	4	1		010	01		010	1				31								31			31		31											58.25	50						54.42	48												50						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	198	0		29	10	S5660_198_0	1	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				31								31			31		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	199	0		29	10	S5660_199_0	1	Preferred Generic	4	001010	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					2.00		6.00													5.00						0.00				10.00				10.00			0.32	0.06				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	199	0		29	10	S5660_199_0	1	Generic	4	010010	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					7.00		21.00													9.00						4.00				20.00				20.00			0.65	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	199	0		29	10	S5660_199_0	1	Preferred Brand	4	010001	1	1	3	1		110	01		100	1				31		90	1	2						90	31		31											57.86	25		25				53.13	23		23												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	199	0		29	10	S5660_199_0	1	Non-Preferred Drug	4	100100	1	1	4	1		010	01		010	1				31								31			31		31											71.97	50						69.09	48												50						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	199	0		29	10	S5660_199_0	1	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				31								31			31		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	202	0		29	10	S5660_202_0	1	Preferred Generic	4	001010	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					2.00		6.00													5.00						0.00				10.00				10.00			0.32	0.06				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	202	0		29	10	S5660_202_0	1	Generic	4	010010	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					7.00		21.00													9.00						4.00				20.00				20.00			0.65	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	202	0		29	10	S5660_202_0	1	Preferred Brand	4	010001	1	1	3	1		110	01		100	1				31		90	1	2						90	31		31											59.09	25		25				54.28	23		23												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	202	0		29	10	S5660_202_0	1	Non-Preferred Drug	4	100100	1	1	4	1		010	01		010	1				31								31			31		31											73.64	50						69.78	48												50						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	202	0		29	10	S5660_202_0	1	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				31								31			31		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	203	0		29	10	S5660_203_0	1	Preferred Generic	4	001010	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					2.00		6.00													5.00						0.00				10.00				10.00			0.32	0.06				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	203	0		29	10	S5660_203_0	1	Generic	4	010010	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					7.00		21.00													9.00						4.00				20.00				20.00			0.65	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	203	0		29	10	S5660_203_0	1	Preferred Brand	4	010001	1	1	3	1		110	01		100	1				31		90	1	2						90	31		31											61.74	24		24				56.84	22		22												24						24			24			24								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	203	0		29	10	S5660_203_0	1	Non-Preferred Drug	4	100100	1	1	4	1		010	01		010	1				31								31			31		31											75.71	50						73.60	48												50						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	203	0		29	10	S5660_203_0	1	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				31								31			31		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	204	0		29	10	S5660_204_0	1	Preferred Generic	4	001010	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					2.00		6.00													5.00						0.00				10.00				10.00			0.32	0.06				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	204	0		29	10	S5660_204_0	1	Generic	4	010010	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					7.00		21.00													9.00						4.00				20.00				20.00			0.65	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	204	0		29	10	S5660_204_0	1	Preferred Brand	4	010001	1	1	3	1		110	01		100	1				31		90	1	2						90	31		31											54.18	24		24				50.26	22		22												24						24			24			24								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	204	0		29	10	S5660_204_0	1	Non-Preferred Drug	4	100100	1	1	4	1		010	01		010	1				31								31			31		31											53.66	50						49.74	48												50						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	204	0		29	10	S5660_204_0	1	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				31								31			31		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	205	0		29	10	S5660_205_0	1	Preferred Generic	4	001010	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					2.00		6.00													5.00						0.00				10.00				10.00			0.32	0.06				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	205	0		29	10	S5660_205_0	1	Generic	4	010010	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					7.00		21.00													9.00						4.00				20.00				20.00			0.65	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	205	0		29	10	S5660_205_0	1	Preferred Brand	4	010001	1	1	3	1		110	01		100	1				31		90	1	2						90	31		31											55.74	25		25				51.28	23		23												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	205	0		29	10	S5660_205_0	1	Non-Preferred Drug	4	100100	1	1	4	1		010	01		010	1				31								31			31		31											51.38	50						49.32	48												50						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	205	0		29	10	S5660_205_0	1	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				31								31			31		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	206	0		29	10	S5660_206_0	1	Preferred Generic	4	001010	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					2.00		6.00													5.00						0.00				10.00				10.00			0.32	0.06				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	206	0		29	10	S5660_206_0	1	Generic	4	010010	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					7.00		21.00													9.00						4.00				20.00				20.00			0.65	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	206	0		29	10	S5660_206_0	1	Preferred Brand	4	010001	1	1	3	1		110	01		100	1				31		90	1	2						90	31		31											65.66	25		25				60.90	23		23												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	206	0		29	10	S5660_206_0	1	Non-Preferred Drug	4	100100	1	1	4	1		010	01		010	1				31								31			31		31											49.02	50						44.27	48												50						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	206	0		29	10	S5660_206_0	1	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				31								31			31		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	207	0		29	10	S5660_207_0	1	Preferred Generic	4	001010	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					2.00		6.00													5.00						0.00				10.00				10.00			0.32	0.06				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	207	0		29	10	S5660_207_0	1	Generic	4	010010	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					7.00		21.00													9.00						4.00				20.00				20.00			0.65	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	207	0		29	10	S5660_207_0	1	Preferred Brand	4	010001	1	1	3	1		110	01		100	1				31		90	1	2						90	31		31											59.02	25		25				54.52	23		23												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	207	0		29	10	S5660_207_0	1	Non-Preferred Drug	4	100100	1	1	4	1		010	01		010	1				31								31			31		31											48.15	50						43.62	48												50						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	207	0		29	10	S5660_207_0	1	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				31								31			31		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	208	0		29	10	S5660_208_0	1	Preferred Generic	4	001010	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					2.00		6.00													5.00						0.00				10.00				10.00			0.32	0.06				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	208	0		29	10	S5660_208_0	1	Generic	4	010010	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					7.00		21.00													9.00						4.00				20.00				20.00			0.65	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	208	0		29	10	S5660_208_0	1	Preferred Brand	4	010001	1	1	3	1		110	01		100	1				31		90	1	2						90	31		31											59.18	25		25				54.47	23		23												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	208	0		29	10	S5660_208_0	1	Non-Preferred Drug	4	100100	1	1	4	1		010	01		010	1				31								31			31		31											47.38	50						45.14	48												50						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	208	0		29	10	S5660_208_0	1	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				31								31			31		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	209	0		29	10	S5660_209_0	1	Preferred Generic	4	001010	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					2.00		6.00													5.00						0.00				10.00				10.00			0.32	0.06				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	209	0		29	10	S5660_209_0	1	Generic	4	010010	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					7.00		21.00													9.00						4.00				20.00				20.00			0.65	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	209	0		29	10	S5660_209_0	1	Preferred Brand	4	010001	1	1	3	1		110	01		100	1				31		90	1	2						90	31		31											65.02	25		25				59.76	23		23												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	209	0		29	10	S5660_209_0	1	Non-Preferred Drug	4	100100	1	1	4	1		010	01		010	1				31								31			31		31											54.13	50						48.22	48												50						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	209	0		29	10	S5660_209_0	1	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				31								31			31		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	210	0		29	10	S5660_210_0	1	Preferred Generic	4	001010	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					2.00		6.00													5.00						0.00				10.00				10.00			0.32	0.06				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	210	0		29	10	S5660_210_0	1	Generic	4	010010	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					7.00		21.00													9.00						4.00				20.00				20.00			0.65	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	210	0		29	10	S5660_210_0	1	Preferred Brand	4	010001	1	1	3	1		110	01		100	1				31		90	1	2						90	31		31											61.49	25		25				55.89	23		23												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	210	0		29	10	S5660_210_0	1	Non-Preferred Drug	4	100100	1	1	4	1		010	01		010	1				31								31			31		31											61.07	50						55.03	48												50						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	210	0		29	10	S5660_210_0	1	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				31								31			31		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	211	0		29	10	S5660_211_0	1	Preferred Generic	4	001010	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					2.00		6.00													5.00						0.00				10.00				10.00			0.32	0.06				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	211	0		29	10	S5660_211_0	1	Generic	4	010010	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					7.00		21.00													9.00						4.00				20.00				20.00			0.65	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	211	0		29	10	S5660_211_0	1	Preferred Brand	4	010001	1	1	3	1		110	01		100	1				31		90	1	2						90	31		31											65.32	25		25				60.01	23		23												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	211	0		29	10	S5660_211_0	1	Non-Preferred Drug	4	100100	1	1	4	1		010	01		010	1				31								31			31		31											53.40	50						50.00	48												50						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	211	0		29	10	S5660_211_0	1	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				31								31			31		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	212	0		29	10	S5660_212_0	1	Preferred Generic	4	001010	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					2.00		6.00													5.00						0.00				10.00				10.00			0.32	0.06				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	212	0		29	10	S5660_212_0	1	Generic	4	010010	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					7.00		21.00													9.00						4.00				20.00				20.00			0.65	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	212	0		29	10	S5660_212_0	1	Preferred Brand	4	010001	1	1	3	1		110	01		100	1				31		90	1	2						90	31		31											58.56	25		25				55.90	23		23												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	212	0		29	10	S5660_212_0	1	Non-Preferred Drug	4	100100	1	1	4	1		010	01		010	1				31								31			31		31											55.39	50						47.49	48												50						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	212	0		29	10	S5660_212_0	1	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				31								31			31		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	213	0		29	10	S5660_213_0	1	Preferred Generic	4	001010	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					2.00		6.00													5.00						0.00				10.00				10.00			0.32	0.06				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	213	0		29	10	S5660_213_0	1	Generic	4	010010	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					7.00		21.00													9.00						4.00				20.00				20.00			0.65	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	213	0		29	10	S5660_213_0	1	Preferred Brand	4	010001	1	1	3	1		110	01		100	1				31		90	1	2						90	31		31											56.66	25		25				52.29	23		23												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	213	0		29	10	S5660_213_0	1	Non-Preferred Drug	4	100100	1	1	4	1		010	01		010	1				31								31			31		31											52.08	50						48.90	48												50						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	213	0		29	10	S5660_213_0	1	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				31								31			31		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	214	0		29	10	S5660_214_0	1	Preferred Generic	4	001010	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					2.00		6.00													5.00						0.00				10.00				10.00			0.32	0.06				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	214	0		29	10	S5660_214_0	1	Generic	4	010010	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					7.00		21.00													9.00						4.00				20.00				20.00			0.65	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	214	0		29	10	S5660_214_0	1	Preferred Brand	4	010001	1	1	3	1		110	01		100	1				31		90	1	2						90	31		31											57.07	25		25				51.73	23		23												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	214	0		29	10	S5660_214_0	1	Non-Preferred Drug	4	100100	1	1	4	1		010	01		010	1				31								31			31		31											44.44	50						39.24	48												50						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	214	0		29	10	S5660_214_0	1	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				31								31			31		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	215	0		29	10	S5660_215_0	1	Preferred Generic	4	001010	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					2.00		6.00													5.00						0.00				10.00				10.00			0.32	0.06				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	215	0		29	10	S5660_215_0	1	Generic	4	010010	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					7.00		21.00													9.00						4.00				20.00				20.00			0.65	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	215	0		29	10	S5660_215_0	1	Preferred Brand	4	010001	1	1	3	1		110	01		100	1				31		90	1	2						90	31		31											63.57	25		25				58.42	23		23												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	215	0		29	10	S5660_215_0	1	Non-Preferred Drug	4	100100	1	1	4	1		010	01		010	1				31								31			31		31											47.86	50						43.34	48												50						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	215	0		29	10	S5660_215_0	1	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				31								31			31		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	216	0		29	10	S5660_216_0	1	Preferred Generic	4	001010	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					2.00		6.00													5.00						0.00				10.00				10.00			0.32	0.06				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	216	0		29	10	S5660_216_0	1	Generic	4	010010	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					7.00		21.00													9.00						4.00				20.00				20.00			0.65	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	216	0		29	10	S5660_216_0	1	Preferred Brand	4	010001	1	1	3	1		110	01		100	1				31		90	1	2						90	31		31											60.37	25		25				57.00	23		23												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	216	0		29	10	S5660_216_0	1	Non-Preferred Drug	4	100100	1	1	4	1		010	01		010	1				31								31			31		31											46.34	50						41.76	48												50						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	216	0		29	10	S5660_216_0	1	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				31								31			31		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	217	0		29	10	S5660_217_0	1	Preferred Generic	4	001010	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					2.00		6.00													5.00						0.00				10.00				10.00			0.32	0.06				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	217	0		29	10	S5660_217_0	1	Generic	4	010010	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					7.00		21.00													9.00						4.00				20.00				20.00			0.65	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	217	0		29	10	S5660_217_0	1	Preferred Brand	4	010001	1	1	3	1		110	01		100	1				31		90	1	2						90	31		31											58.32	25		25				54.15	23		23												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	217	0		29	10	S5660_217_0	1	Non-Preferred Drug	4	100100	1	1	4	1		010	01		010	1				31								31			31		31											39.18	50						35.99	48												50						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5660	217	0		29	10	S5660_217_0	1	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				31								31			31		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5715	001	0		29	10	S5715_001_0	3	Preferred Generic	4	001000	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	001	0		29	10	S5715_001_0	3	Generic	4	010010	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								15.00		45.00					10.00		30.00							45.00																15.00				15.00			0.50	0.33				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	001	0		29	10	S5715_001_0	3	Preferred Brand	4	010001	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					42.00		126.00							141.00																47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	001	0		29	10	S5715_001_0	3	Non-Preferred Brand	4	110000	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								100.00		300.00					95.00		285.00							300.00																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	001	0		29	10	S5715_001_0	3	Specialty Tier	4	010010	1	1	5	1		110	01	100		1				30		90	1	2			90				30		31											665.75	25		25				707.38	25		25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	002	0		29	10	S5715_002_0	3	Preferred Generic	4	001000	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	002	0		29	10	S5715_002_0	3	Preferred Generic	4	001000	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5715	002	0		29	10	S5715_002_0	3	Generic	4	010010	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								7.00		21.00					1.00		3.00							21.00																7.00				7.00			0.23	0.03				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	002	0		29	10	S5715_002_0	3	Generic	4	010010	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								7.00		21.00					1.00		3.00							21.00																7.00				7.00			0.23	0.03				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5715	002	0		29	10	S5715_002_0	3	Preferred Brand	4	010001	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								40.00		120.00					18.00		54.00							120.00																40.00				40.00			1.33	0.60				1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	002	0		29	10	S5715_002_0	3	Preferred Brand	4	010001	1	2	3	3		110	01	100		1				30		90	1	2			90				30		31								40.00		120.00					18.00		54.00							120.00																40.00				40.00			1.33	0.60				1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
S5715	002	0		29	10	S5715_002_0	3	Non-Preferred Brand	4	110000	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								95.00		285.00					70.00		210.00							285.00																95.00				95.00			3.17	2.33				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	002	0		29	10	S5715_002_0	3	Non-Preferred Brand	4	110000	1	2	4	3		110	01	100		1				30		90	1	2			90				30		31								95.00		285.00					70.00		210.00							285.00																95.00				95.00			3.17	2.33				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
S5715	002	0		29	10	S5715_002_0	3	Specialty Tier	4	010010	1	1	5	1		110	01	100		1				30		90	1	2			90				30		31											749.19	33		33				761.35	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	002	0		29	10	S5715_002_0	3	Specialty Tier	4	010010	1	1	5	3		110	01	100		1				30		90	1	2			90				30		31											996.81	31		31				1028.04	31		31						31															31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
S5715	003	0		29	10	S5715_003_0	3	Preferred Generic	4	001000	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	003	0		29	10	S5715_003_0	3	Generic	4	010010	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								15.00		45.00					10.00		30.00							45.00																15.00				15.00			0.50	0.33				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	003	0		29	10	S5715_003_0	3	Preferred Brand	4	010001	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					42.00		126.00							141.00																47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	003	0		29	10	S5715_003_0	3	Non-Preferred Brand	4	110000	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								100.00		300.00					95.00		285.00							300.00																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	003	0		29	10	S5715_003_0	3	Specialty Tier	4	010010	1	1	5	1		110	01	100		1				30		90	1	2			90				30		31											606.35	25		25				627.36	25		25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	004	0		29	10	S5715_004_0	3	Preferred Generic	4	001000	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	004	0		29	10	S5715_004_0	3	Preferred Generic	4	001000	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5715	004	0		29	10	S5715_004_0	3	Generic	4	010010	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								7.00		21.00					1.00		3.00							21.00																7.00				7.00			0.23	0.03				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	004	0		29	10	S5715_004_0	3	Generic	4	010010	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								7.00		21.00					1.00		3.00							21.00																7.00				7.00			0.23	0.03				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5715	004	0		29	10	S5715_004_0	3	Preferred Brand	4	010001	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								40.00		120.00					18.00		54.00							120.00																40.00				40.00			1.33	0.60				1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	004	0		29	10	S5715_004_0	3	Preferred Brand	4	010001	1	2	3	3		110	01	100		1				30		90	1	2			90				30		31								40.00		120.00					18.00		54.00							120.00																40.00				40.00			1.33	0.60				1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
S5715	004	0		29	10	S5715_004_0	3	Non-Preferred Brand	4	110000	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								95.00		285.00					70.00		210.00							285.00																95.00				95.00			3.17	2.33				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	004	0		29	10	S5715_004_0	3	Non-Preferred Brand	4	110000	1	2	4	3		110	01	100		1				30		90	1	2			90				30		31								95.00		285.00					70.00		210.00							285.00																95.00				95.00			3.17	2.33				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
S5715	004	0		29	10	S5715_004_0	3	Specialty Tier	4	010010	1	1	5	1		110	01	100		1				30		90	1	2			90				30		31											937.92	33		33				934.16	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	004	0		29	10	S5715_004_0	3	Specialty Tier	4	010010	1	1	5	3		110	01	100		1				30		90	1	2			90				30		31											1413.15	31		31				1409.54	31		31						31															31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
S5715	005	0		29	10	S5715_005_0	3	Preferred Generic	4	001000	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	005	0		29	10	S5715_005_0	3	Generic	4	010010	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								15.00		45.00					10.00		30.00							45.00																15.00				15.00			0.50	0.33				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	005	0		29	10	S5715_005_0	3	Preferred Brand	4	010001	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					42.00		126.00							141.00																47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	005	0		29	10	S5715_005_0	3	Non-Preferred Brand	4	110000	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								100.00		300.00					95.00		285.00							300.00																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	005	0		29	10	S5715_005_0	3	Specialty Tier	4	010010	1	1	5	1		110	01	100		1				30		90	1	2			90				30		31											591.55	25		25				628.71	25		25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	006	0		29	10	S5715_006_0	3	Preferred Generic	4	001000	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	006	0		29	10	S5715_006_0	3	Preferred Generic	4	001000	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5715	006	0		29	10	S5715_006_0	3	Generic	4	010010	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								7.00		21.00					1.00		3.00							21.00																7.00				7.00			0.23	0.03				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	006	0		29	10	S5715_006_0	3	Generic	4	010010	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								7.00		21.00					1.00		3.00							21.00																7.00				7.00			0.23	0.03				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5715	006	0		29	10	S5715_006_0	3	Preferred Brand	4	010001	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								40.00		120.00					18.00		54.00							120.00																40.00				40.00			1.33	0.60				1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	006	0		29	10	S5715_006_0	3	Preferred Brand	4	010001	1	2	3	3		110	01	100		1				30		90	1	2			90				30		31								40.00		120.00					18.00		54.00							120.00																40.00				40.00			1.33	0.60				1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
S5715	006	0		29	10	S5715_006_0	3	Non-Preferred Brand	4	110000	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								95.00		285.00					70.00		210.00							285.00																95.00				95.00			3.17	2.33				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	006	0		29	10	S5715_006_0	3	Non-Preferred Brand	4	110000	1	2	4	3		110	01	100		1				30		90	1	2			90				30		31								95.00		285.00					70.00		210.00							285.00																95.00				95.00			3.17	2.33				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
S5715	006	0		29	10	S5715_006_0	3	Specialty Tier	4	010010	1	1	5	1		110	01	100		1				30		90	1	2			90				30		31											746.40	33		33				759.35	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	006	0		29	10	S5715_006_0	3	Specialty Tier	4	010010	1	1	5	3		110	01	100		1				30		90	1	2			90				30		31											963.85	31		31				978.06	31		31						31															31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
S5715	010	0		29	10	S5715_010_0	3	Preferred Generic	4	001000	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	010	0		29	10	S5715_010_0	3	Generic	4	010010	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								15.00		45.00					10.00		30.00							45.00																15.00				15.00			0.50	0.33				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	010	0		29	10	S5715_010_0	3	Preferred Brand	4	010001	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								47.00		141.00					42.00		126.00							141.00																47.00				47.00			1.57	1.40				1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	010	0		29	10	S5715_010_0	3	Non-Preferred Brand	4	110000	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								100.00		300.00					95.00		285.00							300.00																100.00				100.00			3.33	3.17				3.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	010	0		29	10	S5715_010_0	3	Specialty Tier	4	010010	1	1	5	1		110	01	100		1				30		90	1	2			90				30		31											650.55	25		25				700.35	25		25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	011	0		29	10	S5715_011_0	3	Preferred Generic	4	001000	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	011	0		29	10	S5715_011_0	3	Preferred Generic	4	001000	1	2	1	3		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5715	011	0		29	10	S5715_011_0	3	Generic	4	010010	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								7.00		21.00					1.00		3.00							21.00																7.00				7.00			0.23	0.03				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	011	0		29	10	S5715_011_0	3	Generic	4	010010	1	2	2	3		110	01	100		1				30		90	1	2			90				30		31								7.00		21.00					1.00		3.00							21.00																7.00				7.00			0.23	0.03				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5715	011	0		29	10	S5715_011_0	3	Preferred Brand	4	010001	1	2	3	1		110	01	100		1				30		90	1	2			90				30		31								40.00		120.00					18.00		54.00							120.00																40.00				40.00			1.33	0.60				1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	011	0		29	10	S5715_011_0	3	Preferred Brand	4	010001	1	2	3	3		110	01	100		1				30		90	1	2			90				30		31								40.00		120.00					18.00		54.00							120.00																40.00				40.00			1.33	0.60				1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
S5715	011	0		29	10	S5715_011_0	3	Non-Preferred Brand	4	110000	1	2	4	1		110	01	100		1				30		90	1	2			90				30		31								95.00		285.00					70.00		210.00							285.00																95.00				95.00			3.17	2.33				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	011	0		29	10	S5715_011_0	3	Non-Preferred Brand	4	110000	1	2	4	3		110	01	100		1				30		90	1	2			90				30		31								95.00		285.00					70.00		210.00							285.00																95.00				95.00			3.17	2.33				3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
S5715	011	0		29	10	S5715_011_0	3	Specialty Tier	4	010010	1	1	5	1		110	01	100		1				30		90	1	2			90				30		31											928.30	33		33				862.15	33		33						33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	011	0		29	10	S5715_011_0	3	Specialty Tier	4	010010	1	1	5	3		110	01	100		1				30		90	1	2			90				30		31											1141.32	31		31				1064.99	31		31						31															31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										2	3	
S5715	012	0		29	10	S5715_012_0	3	Preferred Generic	2	001000	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	012	0		29	10	S5715_012_0	3	Generic	2	010000	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								9.00		27.00					4.00		12.00							27.00																9.00				9.00			0.30	0.13				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	012	0		29	10	S5715_012_0	3	Preferred Brand	2	010001	1	1	3	1		110	01	100		1				30		90	1	2			90				30		31											51.24	21		21				36.46	16		16						21															21			21								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	012	0		29	10	S5715_012_0	3	Non-Preferred Brand	2	110000	1	1	4	1		110	01	100		1				30		90	1	2			90				30		31											68.17	50		50				62.03	45		45						50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	012	0		29	10	S5715_012_0	3	Specialty Tier	2	010010	1	1	5	1		110	01	100		1				30		90	1	2			90				30		31											422.12	25		25				452.97	25		25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	013	0		29	10	S5715_013_0	3	Preferred Generic	2	001000	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	013	0		29	10	S5715_013_0	3	Generic	2	010000	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								7.00		21.00					2.00		6.00							21.00																7.00				7.00			0.23	0.07				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	013	0		29	10	S5715_013_0	3	Preferred Brand	2	010001	1	1	3	1		110	01	100		1				30		90	1	2			90				30		31											44.59	18		18				31.28	13		13						18															18			18								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	013	0		29	10	S5715_013_0	3	Non-Preferred Brand	2	110000	1	1	4	1		110	01	100		1				30		90	1	2			90				30		31											65.25	47		47				59.16	42		42						47															47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	013	0		29	10	S5715_013_0	3	Specialty Tier	2	010010	1	1	5	1		110	01	100		1				30		90	1	2			90				30		31											395.32	25		25				404.51	25		25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	014	0		29	10	S5715_014_0	3	Preferred Generic	2	001000	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	014	0		29	10	S5715_014_0	3	Generic	2	010000	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								7.00		21.00					2.00		6.00							21.00																7.00				7.00			0.23	0.07				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	014	0		29	10	S5715_014_0	3	Preferred Brand	2	010001	1	1	3	1		110	01	100		1				30		90	1	2			90				30		31											58.82	20		20				41.87	15		15						20															20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	014	0		29	10	S5715_014_0	3	Non-Preferred Brand	2	110000	1	1	4	1		110	01	100		1				30		90	1	2			90				30		31											71.53	50		50				64.33	45		45						50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	014	0		29	10	S5715_014_0	3	Specialty Tier	2	010010	1	1	5	1		110	01	100		1				30		90	1	2			90				30		31											416.97	25		25				425.84	25		25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	015	0		29	10	S5715_015_0	3	Preferred Generic	2	001000	1	2	1	1		110	01	100		1				30		90	1	2			90				30		31								5.00		15.00					0.00		0.00							15.00																5.00				5.00			0.17	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	015	0		29	10	S5715_015_0	3	Generic	2	010000	1	2	2	1		110	01	100		1				30		90	1	2			90				30		31								7.00		21.00					2.00		6.00							21.00																7.00				7.00			0.23	0.07				0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	015	0		29	10	S5715_015_0	3	Preferred Brand	2	010001	1	1	3	1		110	01	100		1				30		90	1	2			90				30		31											64.42	24		24				50.09	19		19						24															24			24								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	015	0		29	10	S5715_015_0	3	Non-Preferred Brand	2	110000	1	1	4	1		110	01	100		1				30		90	1	2			90				30		31											64.81	50		50				57.75	45		45						50															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5715	015	0		29	10	S5715_015_0	3	Specialty Tier	2	010010	1	1	5	1		110	01	100		1				30		90	1	2			90				30		31											415.96	25		25				442.54	25		25						25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5726	013	0		29	10	S5726_013_0	3	Preferred Generic	3	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								19.00	38.00	57.00					2.00	4.00	6.00					2.00	6.00	6.00																19.00				19.00			0.63	0.07	0.07			0.56	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5726	013	0		29	10	S5726_013_0	3	Generic	3	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								20.00	40.00	60.00					7.00	14.00	21.00					7.00	21.00	21.00																20.00				20.00			0.67	0.23	0.23			0.59	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5726	013	0		29	10	S5726_013_0	3	Preferred Brand	3	000101	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								47.00	94.00	141.00					32.00	64.00	96.00					32.00	96.00	96.00																47.00				47.00			1.57	1.07	1.07			1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5726	013	0		29	10	S5726_013_0	3	Non-Preferred Drug	3	100100	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34											59.32	50	50	50				47.46	40	40	40				40	40	40															50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5726	013	0		29	10	S5726_013_0	3	Specialty Tier	3	010010	1	1	5	1		010	01	010		1				30					30						30		34												25							25						25																	25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5726	013	0		29	10	S5726_013_0	3	Select Care Drugs	3	001000	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								11.00	22.00	33.00					0.00	0.00	0.00					0.00	0.00	0.00																11.00				11.00			0.37	0.00	0.00			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5726	014	0		29	10	S5726_014_0	3	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					1.00	2.00	3.00					1.00	3.00	3.00																9.00				9.00			0.30	0.03	0.03			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5726	014	0		29	10	S5726_014_0	3	Preferred Generic	4	001000	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								9.00	18.00	27.00					1.00	2.00	3.00					1.00	3.00	3.00																9.00				9.00			0.30	0.03	0.03			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5726	014	0		29	10	S5726_014_0	3	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5726	014	0		29	10	S5726_014_0	3	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								45.00	90.00	135.00					40.00	80.00	120.00					40.00	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, Select Care Drugs												
S5726	014	0		29	10	S5726_014_0	3	Non-Preferred Drug	4	100100	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34											83.98	47	47	47				69.69	39	39	39				39	39	39															47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5726	014	0		29	10	S5726_014_0	3	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5726	014	0		29	10	S5726_014_0	3	Select Care Drugs	4	001000	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5726	014	0		29	10	S5726_014_0	3	Select Care Drugs	4	001000	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								5.00	10.00	15.00					0.00	0.00	0.00					0.00	0.00	0.00																5.00				5.00			0.17	0.00	0.00			0.15	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5726	015	0		29	10	S5726_015_0	3	Preferred Generic	4	001000	1	2	1	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5726	015	0		29	10	S5726_015_0	3	Preferred Generic	4	001000	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5726	015	0		29	10	S5726_015_0	3	Generic	4	010000	1	2	2	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5726	015	0		29	10	S5726_015_0	3	Generic	4	010000	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								17.00	34.00	51.00					3.00	6.00	9.00					3.00	9.00	9.00																17.00				17.00			0.57	0.10	0.10			0.50	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5726	015	0		29	10	S5726_015_0	3	Preferred Brand	4	000101	1	2	3	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								45.00	90.00	135.00					25.00	50.00	75.00					25.00	75.00	75.00																45.00				45.00			1.50	0.83	0.83			1.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5726	015	0		29	10	S5726_015_0	3	Preferred Brand	4	000101	1	1	3	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34											100.58	60	60	60				98.90	59	59	59				60	60	60															60			60								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										2	1	
S5726	015	0		29	10	S5726_015_0	3	Non-Preferred Drug	4	100100	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34											83.33	40	40	40				72.91	35	35	35				35	35	35															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5726	015	0		29	10	S5726_015_0	3	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				30					30						30		34												33							33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5726	015	0		29	10	S5726_015_0	3	Select Care Drugs	4	001000	1	2	6	1		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5726	015	0		29	10	S5726_015_0	3	Select Care Drugs	4	001000	1	2	6	3		111	01	111		1				30	60	90	1	2	30	60	90				30		34								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			0.26	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5743	001	0		29	10	S5743_001_0	4	Preferred Generic	3	001001	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								13.00	26.00	26.00					1.00	2.00	2.00											13.00	26.00	26.00				1.00	2.00	2.00				13.00				13.00			0.43	0.03		0.43	0.03	0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5743	001	0		29	10	S5743_001_0	4	Generic	3	010001	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								19.00	38.00	38.00					6.00	12.00	12.00											19.00	38.00	38.00				6.00	12.00	12.00				19.00				19.00			0.63	0.20		0.63	0.20	0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5743	001	0		29	10	S5743_001_0	4	Preferred Brand	3	000101	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											58.77	25	25	25				25.49	18	18	18										25	25	25				18	18	18			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5743	001	0		29	10	S5743_001_0	4	Non-Preferred Drug	3	100100	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											89.33	50	50	50				37.66	35	35	35										50	50	50				35	35	35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5743	001	0		29	10	S5743_001_0	4	Specialty Tier	3	010010	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												25	25	25					25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5743	004	0		29	10	S5743_004_0	3	Preferred Generic	4	001001	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	001001	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	010001	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	010001	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	000101	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											30.27	25	25	25				13.13	18	18	18										25	25	25				18	18	18			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	100100	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											80.60	50	50	50				43.69	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5743	004	0		29	10	S5743_004_0	3	Specialty Tier	4	010010	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												33	33	33					33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5753	006	0		29	10	S5753_006_0	3	Preferred Generic	2	001000	1	2	1	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31	1.00	2.00	3.00																			1.00	2.00	2.50																	1.00			1.00		0.03			0.03			0.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5753	006	0		29	10	S5753_006_0	3	Generic	2	010000	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31	17.00	34.00	51.00																			17.00	34.00	42.50																	17.00			17.00		0.57			0.57			0.55	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5753	006	0		29	10	S5753_006_0	3	Preferred Brand	2	000001	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	117.50																	47.00			47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5753	006	0		29	10	S5753_006_0	3	Non-Preferred Drug	2	110000	1	1	4	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31				80.84	50	50	50																		50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5753	006	0		29	10	S5753_006_0	3	Specialty Tier	2	010010	1	1	5	1	010		10	010		1	30								30							29	31					25																				25																		25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5753	007	0		29	10	S5753_007_0	3	Preferred Generic	4	001000	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 Drug, Specialty Tier												
S5753	007	0		29	10	S5753_007_0	3	Preferred Generic	4	001000	1	2	1	3	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 Drug, Specialty Tier										1		
S5753	007	0		29	10	S5753_007_0	3	Generic	4	010000	1	2	2	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31	19.00	38.00	57.00																			19.00	38.00	47.50																	19.00			19.00		0.63			0.63			0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5753	007	0		29	10	S5753_007_0	3	Generic	4	010000	1	2	2	3	111		10	111		1	30	60	90				1	2	30	60	90					29	31	19.00	38.00	57.00																			19.00	38.00	47.50																	19.00			19.00		0.63			0.63			0.61	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5753	007	0		29	10	S5753_007_0	3	Preferred Brand	4	000001	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	117.50																	47.00			47.00		1.57			1.57			1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5753	007	0		29	10	S5753_007_0	3	Non-Preferred Drug	4	110000	1	1	4	1	111		10	111		1	30	60	90				1	2	30	60	90					29	31				83.83	50	50	50																		50	50	50																50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5753	007	0		29	10	S5753_007_0	3	Specialty Tier	4	010010	1	1	5	1	010		10	010		1	30								30							29	31					33																				33																		33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	125	0		29	10	S5768_125_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	125	0		29	10	S5768_125_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	125	0		29	10	S5768_125_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	125	0		29	10	S5768_125_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	125	0		29	10	S5768_125_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	125	0		29	10	S5768_125_0	3	Non-Preferred Drug	4	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											64.31	50	50	50				49.22	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	125	0		29	10	S5768_125_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	126	0		29	10	S5768_126_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	126	0		29	10	S5768_126_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	126	0		29	10	S5768_126_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	126	0		29	10	S5768_126_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	126	0		29	10	S5768_126_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	126	0		29	10	S5768_126_0	3	Non-Preferred Drug	4	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											69.01	50	50	50				53.92	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	126	0		29	10	S5768_126_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	127	0		29	10	S5768_127_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	127	0		29	10	S5768_127_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	127	0		29	10	S5768_127_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	127	0		29	10	S5768_127_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	127	0		29	10	S5768_127_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	127	0		29	10	S5768_127_0	3	Non-Preferred Drug	4	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											63.24	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												
S5768	127	0		29	10	S5768_127_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	128	0		29	10	S5768_128_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	128	0		29	10	S5768_128_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	128	0		29	10	S5768_128_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	128	0		29	10	S5768_128_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	128	0		29	10	S5768_128_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	128	0		29	10	S5768_128_0	3	Non-Preferred Drug	4	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											71.35	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												
S5768	128	0		29	10	S5768_128_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	129	0		29	10	S5768_129_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	129	0		29	10	S5768_129_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	129	0		29	10	S5768_129_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	129	0		29	10	S5768_129_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	129	0		29	10	S5768_129_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	129	0		29	10	S5768_129_0	3	Non-Preferred Drug	4	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											59.48	50	50	50				45.34	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	129	0		29	10	S5768_129_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	130	0		29	10	S5768_130_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	130	0		29	10	S5768_130_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	130	0		29	10	S5768_130_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	130	0		29	10	S5768_130_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	130	0		29	10	S5768_130_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	130	0		29	10	S5768_130_0	3	Non-Preferred Drug	4	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											68.56	50	50	50				52.26	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	130	0		29	10	S5768_130_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	131	0		29	10	S5768_131_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	131	0		29	10	S5768_131_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	131	0		29	10	S5768_131_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	131	0		29	10	S5768_131_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	131	0		29	10	S5768_131_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	131	0		29	10	S5768_131_0	3	Non-Preferred Drug	4	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											68.10	50	50	50				51.60	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	131	0		29	10	S5768_131_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	132	0		29	10	S5768_132_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	132	0		29	10	S5768_132_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	132	0		29	10	S5768_132_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	132	0		29	10	S5768_132_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	132	0		29	10	S5768_132_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	132	0		29	10	S5768_132_0	3	Non-Preferred Drug	4	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											67.74	50	50	50				51.68	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	132	0		29	10	S5768_132_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	133	0		29	10	S5768_133_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	133	0		29	10	S5768_133_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	133	0		29	10	S5768_133_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	133	0		29	10	S5768_133_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	133	0		29	10	S5768_133_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	133	0		29	10	S5768_133_0	3	Non-Preferred Drug	4	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											68.54	50	50	50				51.53	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	133	0		29	10	S5768_133_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	134	0		29	10	S5768_134_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	134	0		29	10	S5768_134_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	134	0		29	10	S5768_134_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	134	0		29	10	S5768_134_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	134	0		29	10	S5768_134_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	134	0		29	10	S5768_134_0	3	Non-Preferred Drug	4	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											62.57	50	50	50				47.87	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	134	0		29	10	S5768_134_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	135	0		29	10	S5768_135_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	135	0		29	10	S5768_135_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	135	0		29	10	S5768_135_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	135	0		29	10	S5768_135_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	135	0		29	10	S5768_135_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	135	0		29	10	S5768_135_0	3	Non-Preferred Drug	4	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											67.70	50	50	50				49.11	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	135	0		29	10	S5768_135_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	136	0		29	10	S5768_136_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	136	0		29	10	S5768_136_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	136	0		29	10	S5768_136_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	136	0		29	10	S5768_136_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	136	0		29	10	S5768_136_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	136	0		29	10	S5768_136_0	3	Non-Preferred Drug	4	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											75.28	50	50	50				53.15	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	136	0		29	10	S5768_136_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	137	0		29	10	S5768_137_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	137	0		29	10	S5768_137_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	137	0		29	10	S5768_137_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	137	0		29	10	S5768_137_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	137	0		29	10	S5768_137_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	137	0		29	10	S5768_137_0	3	Non-Preferred Drug	4	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											68.78	50	50	50				50.46	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	137	0		29	10	S5768_137_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	138	0		29	10	S5768_138_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	138	0		29	10	S5768_138_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	138	0		29	10	S5768_138_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	138	0		29	10	S5768_138_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	138	0		29	10	S5768_138_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								43.00	86.00	129.00					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	1.43	1.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	138	0		29	10	S5768_138_0	3	Non-Preferred Drug	4	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											69.13	50	50	50				52.34	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	138	0		29	10	S5768_138_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	139	0		29	10	S5768_139_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	139	0		29	10	S5768_139_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	139	0		29	10	S5768_139_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	139	0		29	10	S5768_139_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	139	0		29	10	S5768_139_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	139	0		29	10	S5768_139_0	3	Non-Preferred Drug	4	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											65.63	50	50	50				50.06	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	139	0		29	10	S5768_139_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	140	0		29	10	S5768_140_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	140	0		29	10	S5768_140_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	140	0		29	10	S5768_140_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	140	0		29	10	S5768_140_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	140	0		29	10	S5768_140_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	140	0		29	10	S5768_140_0	3	Non-Preferred Drug	4	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											62.66	50	50	50				47.81	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	140	0		29	10	S5768_140_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	141	0		29	10	S5768_141_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	141	0		29	10	S5768_141_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	141	0		29	10	S5768_141_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	141	0		29	10	S5768_141_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	141	0		29	10	S5768_141_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	141	0		29	10	S5768_141_0	3	Non-Preferred Drug	4	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											66.17	50	50	50				50.93	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	141	0		29	10	S5768_141_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	142	0		29	10	S5768_142_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	142	0		29	10	S5768_142_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	142	0		29	10	S5768_142_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	142	0		29	10	S5768_142_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	142	0		29	10	S5768_142_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	142	0		29	10	S5768_142_0	3	Non-Preferred Drug	4	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											65.26	50	50	50				48.94	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	142	0		29	10	S5768_142_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	143	0		29	10	S5768_143_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	143	0		29	10	S5768_143_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	143	0		29	10	S5768_143_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	143	0		29	10	S5768_143_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	143	0		29	10	S5768_143_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	143	0		29	10	S5768_143_0	3	Non-Preferred Drug	4	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											56.14	50	50	50				44.05	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	143	0		29	10	S5768_143_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	144	0		29	10	S5768_144_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	144	0		29	10	S5768_144_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	144	0		29	10	S5768_144_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	144	0		29	10	S5768_144_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	144	0		29	10	S5768_144_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	144	0		29	10	S5768_144_0	3	Non-Preferred Drug	4	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											57.74	50	50	50				46.25	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	144	0		29	10	S5768_144_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	145	0		29	10	S5768_145_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	145	0		29	10	S5768_145_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	145	0		29	10	S5768_145_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	145	0		29	10	S5768_145_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	145	0		29	10	S5768_145_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	145	0		29	10	S5768_145_0	3	Non-Preferred Drug	4	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											67.49	50	50	50				50.54	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	145	0		29	10	S5768_145_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	146	0		29	10	S5768_146_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	146	0		29	10	S5768_146_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	146	0		29	10	S5768_146_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	146	0		29	10	S5768_146_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	146	0		29	10	S5768_146_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								43.00	86.00	129.00					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	1.43	1.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	146	0		29	10	S5768_146_0	3	Non-Preferred Drug	4	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											79.50	50	50	50				54.75	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	146	0		29	10	S5768_146_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	147	0		29	10	S5768_147_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	147	0		29	10	S5768_147_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	147	0		29	10	S5768_147_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	147	0		29	10	S5768_147_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	147	0		29	10	S5768_147_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	147	0		29	10	S5768_147_0	3	Non-Preferred Drug	4	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											63.35	50	50	50				48.37	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	147	0		29	10	S5768_147_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	148	0		29	10	S5768_148_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	148	0		29	10	S5768_148_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	148	0		29	10	S5768_148_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	148	0		29	10	S5768_148_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	148	0		29	10	S5768_148_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	148	0		29	10	S5768_148_0	3	Non-Preferred Drug	4	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											62.55	50	50	50				49.88	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	148	0		29	10	S5768_148_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	149	0		29	10	S5768_149_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	149	0		29	10	S5768_149_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	149	0		29	10	S5768_149_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	149	0		29	10	S5768_149_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	149	0		29	10	S5768_149_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	149	0		29	10	S5768_149_0	3	Non-Preferred Drug	4	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											60.53	50	50	50				47.78	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	149	0		29	10	S5768_149_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	150	0		29	10	S5768_150_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	150	0		29	10	S5768_150_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	150	0		29	10	S5768_150_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	150	0		29	10	S5768_150_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	150	0		29	10	S5768_150_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	150	0		29	10	S5768_150_0	3	Non-Preferred Drug	4	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											75.17	50	50	50				58.30	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	150	0		29	10	S5768_150_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	151	0		29	10	S5768_151_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	151	0		29	10	S5768_151_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	151	0		29	10	S5768_151_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	151	0		29	10	S5768_151_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	151	0		29	10	S5768_151_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	151	0		29	10	S5768_151_0	3	Non-Preferred Drug	4	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											66.12	50	50	50				52.89	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	151	0		29	10	S5768_151_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	152	0		29	10	S5768_152_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	152	0		29	10	S5768_152_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	152	0		29	10	S5768_152_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	152	0		29	10	S5768_152_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	152	0		29	10	S5768_152_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	152	0		29	10	S5768_152_0	3	Non-Preferred Drug	4	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											70.58	50	50	50				56.15	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	152	0		29	10	S5768_152_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	153	0		29	10	S5768_153_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	153	0		29	10	S5768_153_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	153	0		29	10	S5768_153_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	153	0		29	10	S5768_153_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	153	0		29	10	S5768_153_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	153	0		29	10	S5768_153_0	3	Non-Preferred Drug	4	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											64.31	50	50	50				50.47	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	153	0		29	10	S5768_153_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	154	0		29	10	S5768_154_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	154	0		29	10	S5768_154_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	154	0		29	10	S5768_154_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	154	0		29	10	S5768_154_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	154	0		29	10	S5768_154_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	154	0		29	10	S5768_154_0	3	Non-Preferred Drug	4	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											69.70	50	50	50				50.91	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	154	0		29	10	S5768_154_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	155	0		29	10	S5768_155_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	155	0		29	10	S5768_155_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	155	0		29	10	S5768_155_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	155	0		29	10	S5768_155_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	155	0		29	10	S5768_155_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	155	0		29	10	S5768_155_0	3	Non-Preferred Drug	4	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											72.52	50	50	50				58.70	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	155	0		29	10	S5768_155_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	164	0		29	10	S5768_164_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	164	0		29	10	S5768_164_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	164	0		29	10	S5768_164_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	164	0		29	10	S5768_164_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	164	0		29	10	S5768_164_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								34.00	68.00	102.00					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	1.13	1.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	164	0		29	10	S5768_164_0	3	Non-Preferred Drug	4	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											70.52	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												
S5768	164	0		29	10	S5768_164_0	3	Non-Preferred Drug	4	100100	1	1	4	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31											66.28	50	50	50				42.14	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5768	164	0		29	10	S5768_164_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	165	0		29	10	S5768_165_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	165	0		29	10	S5768_165_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	165	0		29	10	S5768_165_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	165	0		29	10	S5768_165_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	165	0		29	10	S5768_165_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								34.00	68.00	102.00					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	1.13	1.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	165	0		29	10	S5768_165_0	3	Non-Preferred Drug	4	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											58.39	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												
S5768	165	0		29	10	S5768_165_0	3	Non-Preferred Drug	4	100100	1	1	4	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31											69.04	50	50	50				43.18	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5768	165	0		29	10	S5768_165_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	166	0		29	10	S5768_166_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	166	0		29	10	S5768_166_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	166	0		29	10	S5768_166_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	166	0		29	10	S5768_166_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	166	0		29	10	S5768_166_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								34.00	68.00	102.00					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	1.13	1.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	166	0		29	10	S5768_166_0	3	Non-Preferred Drug	4	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											64.65	50	50	50				56.37	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	166	0		29	10	S5768_166_0	3	Non-Preferred Drug	4	100100	1	1	4	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31											71.36	50	50	50				48.89	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5768	166	0		29	10	S5768_166_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	167	0		29	10	S5768_167_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	167	0		29	10	S5768_167_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	167	0		29	10	S5768_167_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	167	0		29	10	S5768_167_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	167	0		29	10	S5768_167_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								34.00	68.00	102.00					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	1.13	1.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	167	0		29	10	S5768_167_0	3	Non-Preferred Drug	4	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											62.29	50	50	50				54.27	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	167	0		29	10	S5768_167_0	3	Non-Preferred Drug	4	100100	1	1	4	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31											68.69	50	50	50				43.48	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5768	167	0		29	10	S5768_167_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	168	0		29	10	S5768_168_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	168	0		29	10	S5768_168_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	168	0		29	10	S5768_168_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	168	0		29	10	S5768_168_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	168	0		29	10	S5768_168_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								34.00	68.00	102.00					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	1.13	1.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	168	0		29	10	S5768_168_0	3	Non-Preferred Drug	4	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											55.43	50	50	50				47.23	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	168	0		29	10	S5768_168_0	3	Non-Preferred Drug	4	100100	1	1	4	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31											64.70	50	50	50				40.45	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5768	168	0		29	10	S5768_168_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	169	0		29	10	S5768_169_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	169	0		29	10	S5768_169_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	169	0		29	10	S5768_169_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	169	0		29	10	S5768_169_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	169	0		29	10	S5768_169_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								34.00	68.00	102.00					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	1.13	1.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	169	0		29	10	S5768_169_0	3	Non-Preferred Drug	4	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											60.53	50	50	50				52.49	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	169	0		29	10	S5768_169_0	3	Non-Preferred Drug	4	100100	1	1	4	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31											68.32	50	50	50				42.29	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5768	169	0		29	10	S5768_169_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	170	0		29	10	S5768_170_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	170	0		29	10	S5768_170_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	170	0		29	10	S5768_170_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	170	0		29	10	S5768_170_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	170	0		29	10	S5768_170_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								34.00	68.00	102.00					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	1.13	1.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	170	0		29	10	S5768_170_0	3	Non-Preferred Drug	4	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											60.52	50	50	50				49.74	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	170	0		29	10	S5768_170_0	3	Non-Preferred Drug	4	100100	1	1	4	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31											85.12	50	50	50				48.68	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5768	170	0		29	10	S5768_170_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	171	0		29	10	S5768_171_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	171	0		29	10	S5768_171_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	171	0		29	10	S5768_171_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	171	0		29	10	S5768_171_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	171	0		29	10	S5768_171_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								34.00	68.00	102.00					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	1.13	1.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	171	0		29	10	S5768_171_0	3	Non-Preferred Drug	4	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											66.95	50	50	50				55.79	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	171	0		29	10	S5768_171_0	3	Non-Preferred Drug	4	100100	1	1	4	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31											89.36	50	50	50				51.62	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5768	171	0		29	10	S5768_171_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	172	0		29	10	S5768_172_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	172	0		29	10	S5768_172_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	172	0		29	10	S5768_172_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	172	0		29	10	S5768_172_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	172	0		29	10	S5768_172_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								34.00	68.00	102.00					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	1.13	1.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	172	0		29	10	S5768_172_0	3	Non-Preferred Drug	4	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											69.10	50	50	50				57.79	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	172	0		29	10	S5768_172_0	3	Non-Preferred Drug	4	100100	1	1	4	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31											72.69	50	50	50				39.46	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5768	172	0		29	10	S5768_172_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	173	0		29	10	S5768_173_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	173	0		29	10	S5768_173_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	173	0		29	10	S5768_173_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	173	0		29	10	S5768_173_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	173	0		29	10	S5768_173_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								34.00	68.00	102.00					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	1.13	1.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	173	0		29	10	S5768_173_0	3	Non-Preferred Drug	4	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											67.18	50	50	50				55.72	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	173	0		29	10	S5768_173_0	3	Non-Preferred Drug	4	100100	1	1	4	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31											76.76	50	50	50				38.89	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5768	173	0		29	10	S5768_173_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	174	0		29	10	S5768_174_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	174	0		29	10	S5768_174_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	174	0		29	10	S5768_174_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	174	0		29	10	S5768_174_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	174	0		29	10	S5768_174_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								34.00	68.00	102.00					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	1.13	1.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	174	0		29	10	S5768_174_0	3	Non-Preferred Drug	4	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											65.90	50	50	50				56.93	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	174	0		29	10	S5768_174_0	3	Non-Preferred Drug	4	100100	1	1	4	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31											68.87	50	50	50				39.99	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5768	174	0		29	10	S5768_174_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	175	0		29	10	S5768_175_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	175	0		29	10	S5768_175_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	175	0		29	10	S5768_175_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	175	0		29	10	S5768_175_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	175	0		29	10	S5768_175_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								34.00	68.00	102.00					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	1.13	1.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	175	0		29	10	S5768_175_0	3	Non-Preferred Drug	4	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											65.57	50	50	50				58.79	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	175	0		29	10	S5768_175_0	3	Non-Preferred Drug	4	100100	1	1	4	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31											73.92	50	50	50				43.24	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5768	175	0		29	10	S5768_175_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	176	0		29	10	S5768_176_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	176	0		29	10	S5768_176_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	176	0		29	10	S5768_176_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	176	0		29	10	S5768_176_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	176	0		29	10	S5768_176_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								34.00	68.00	102.00					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	1.13	1.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	176	0		29	10	S5768_176_0	3	Non-Preferred Drug	4	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											57.89	50	50	50				47.72	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	176	0		29	10	S5768_176_0	3	Non-Preferred Drug	4	100100	1	1	4	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31											74.43	50	50	50				40.33	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5768	176	0		29	10	S5768_176_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	177	0		29	10	S5768_177_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	177	0		29	10	S5768_177_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	177	0		29	10	S5768_177_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	177	0		29	10	S5768_177_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	177	0		29	10	S5768_177_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								34.00	68.00	102.00					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	1.13	1.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	177	0		29	10	S5768_177_0	3	Non-Preferred Drug	4	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											59.22	50	50	50				51.36	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	177	0		29	10	S5768_177_0	3	Non-Preferred Drug	4	100100	1	1	4	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31											67.16	50	50	50				39.68	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5768	177	0		29	10	S5768_177_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	178	0		29	10	S5768_178_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	178	0		29	10	S5768_178_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	178	0		29	10	S5768_178_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	178	0		29	10	S5768_178_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	178	0		29	10	S5768_178_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								34.00	68.00	102.00					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	1.13	1.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	178	0		29	10	S5768_178_0	3	Non-Preferred Drug	4	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											74.00	50	50	50				66.76	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	178	0		29	10	S5768_178_0	3	Non-Preferred Drug	4	100100	1	1	4	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31											68.02	50	50	50				38.09	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5768	178	0		29	10	S5768_178_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	179	0		29	10	S5768_179_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	179	0		29	10	S5768_179_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	179	0		29	10	S5768_179_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	179	0		29	10	S5768_179_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	179	0		29	10	S5768_179_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								34.00	68.00	102.00					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	1.13	1.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	179	0		29	10	S5768_179_0	3	Non-Preferred Drug	4	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											68.43	50	50	50				58.02	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	179	0		29	10	S5768_179_0	3	Non-Preferred Drug	4	100100	1	1	4	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31											69.97	50	50	50				37.13	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5768	179	0		29	10	S5768_179_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	180	0		29	10	S5768_180_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	180	0		29	10	S5768_180_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	180	0		29	10	S5768_180_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	180	0		29	10	S5768_180_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	180	0		29	10	S5768_180_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								34.00	68.00	102.00					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	1.13	1.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	180	0		29	10	S5768_180_0	3	Non-Preferred Drug	4	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											66.84	50	50	50				57.21	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	180	0		29	10	S5768_180_0	3	Non-Preferred Drug	4	100100	1	1	4	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31											77.08	50	50	50				42.51	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5768	180	0		29	10	S5768_180_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	181	0		29	10	S5768_181_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	181	0		29	10	S5768_181_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	181	0		29	10	S5768_181_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	181	0		29	10	S5768_181_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	181	0		29	10	S5768_181_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								34.00	68.00	102.00					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	1.13	1.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	181	0		29	10	S5768_181_0	3	Non-Preferred Drug	4	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											64.01	50	50	50				56.51	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	181	0		29	10	S5768_181_0	3	Non-Preferred Drug	4	100100	1	1	4	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31											66.08	50	50	50				35.30	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5768	181	0		29	10	S5768_181_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	182	0		29	10	S5768_182_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	182	0		29	10	S5768_182_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	182	0		29	10	S5768_182_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	182	0		29	10	S5768_182_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	182	0		29	10	S5768_182_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								34.00	68.00	102.00					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	1.13	1.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	182	0		29	10	S5768_182_0	3	Non-Preferred Drug	4	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											76.22	50	50	50				62.28	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	182	0		29	10	S5768_182_0	3	Non-Preferred Drug	4	100100	1	1	4	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31											84.33	50	50	50				44.78	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5768	182	0		29	10	S5768_182_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	183	0		29	10	S5768_183_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	183	0		29	10	S5768_183_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	183	0		29	10	S5768_183_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	183	0		29	10	S5768_183_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	183	0		29	10	S5768_183_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								34.00	68.00	102.00					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	1.13	1.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	183	0		29	10	S5768_183_0	3	Non-Preferred Drug	4	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											69.76	50	50	50				59.35	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	183	0		29	10	S5768_183_0	3	Non-Preferred Drug	4	100100	1	1	4	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31											71.07	50	50	50				41.82	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5768	183	0		29	10	S5768_183_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	184	0		29	10	S5768_184_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	184	0		29	10	S5768_184_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	184	0		29	10	S5768_184_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	184	0		29	10	S5768_184_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	184	0		29	10	S5768_184_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								34.00	68.00	102.00					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	1.13	1.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	184	0		29	10	S5768_184_0	3	Non-Preferred Drug	4	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											64.20	50	50	50				54.62	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	184	0		29	10	S5768_184_0	3	Non-Preferred Drug	4	100100	1	1	4	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31											69.38	50	50	50				41.52	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5768	184	0		29	10	S5768_184_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	185	0		29	10	S5768_185_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	185	0		29	10	S5768_185_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	185	0		29	10	S5768_185_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	185	0		29	10	S5768_185_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	185	0		29	10	S5768_185_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								34.00	68.00	102.00					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	1.13	1.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	185	0		29	10	S5768_185_0	3	Non-Preferred Drug	4	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											59.45	50	50	50				52.85	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	185	0		29	10	S5768_185_0	3	Non-Preferred Drug	4	100100	1	1	4	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31											66.23	50	50	50				41.22	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5768	185	0		29	10	S5768_185_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	186	0		29	10	S5768_186_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	186	0		29	10	S5768_186_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	186	0		29	10	S5768_186_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	186	0		29	10	S5768_186_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	186	0		29	10	S5768_186_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								34.00	68.00	102.00					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	1.13	1.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	186	0		29	10	S5768_186_0	3	Non-Preferred Drug	4	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											61.82	50	50	50				53.29	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	186	0		29	10	S5768_186_0	3	Non-Preferred Drug	4	100100	1	1	4	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31											81.82	50	50	50				48.53	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5768	186	0		29	10	S5768_186_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	187	0		29	10	S5768_187_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	187	0		29	10	S5768_187_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	187	0		29	10	S5768_187_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	187	0		29	10	S5768_187_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	187	0		29	10	S5768_187_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								34.00	68.00	102.00					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	1.13	1.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	187	0		29	10	S5768_187_0	3	Non-Preferred Drug	4	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											58.01	50	50	50				51.81	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	187	0		29	10	S5768_187_0	3	Non-Preferred Drug	4	100100	1	1	4	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31											56.71	50	50	50				36.97	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5768	187	0		29	10	S5768_187_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	188	0		29	10	S5768_188_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	188	0		29	10	S5768_188_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	188	0		29	10	S5768_188_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	188	0		29	10	S5768_188_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	188	0		29	10	S5768_188_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								34.00	68.00	102.00					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	1.13	1.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	188	0		29	10	S5768_188_0	3	Non-Preferred Drug	4	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											64.09	50	50	50				55.69	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	188	0		29	10	S5768_188_0	3	Non-Preferred Drug	4	100100	1	1	4	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31											66.45	50	50	50				37.42	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5768	188	0		29	10	S5768_188_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	189	0		29	10	S5768_189_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	189	0		29	10	S5768_189_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	189	0		29	10	S5768_189_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	189	0		29	10	S5768_189_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	189	0		29	10	S5768_189_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								34.00	68.00	102.00					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	1.13	1.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	189	0		29	10	S5768_189_0	3	Non-Preferred Drug	4	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											65.29	50	50	50				57.71	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	189	0		29	10	S5768_189_0	3	Non-Preferred Drug	4	100100	1	1	4	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31											73.16	50	50	50				40.23	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5768	189	0		29	10	S5768_189_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	190	0		29	10	S5768_190_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	190	0		29	10	S5768_190_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	190	0		29	10	S5768_190_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	190	0		29	10	S5768_190_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	190	0		29	10	S5768_190_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								34.00	68.00	102.00					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	1.13	1.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	190	0		29	10	S5768_190_0	3	Non-Preferred Drug	4	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											67.70	50	50	50				58.08	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	190	0		29	10	S5768_190_0	3	Non-Preferred Drug	4	100100	1	1	4	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31											62.92	50	50	50				36.20	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5768	190	0		29	10	S5768_190_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	191	0		29	10	S5768_191_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	191	0		29	10	S5768_191_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	191	0		29	10	S5768_191_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	191	0		29	10	S5768_191_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	191	0		29	10	S5768_191_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								34.00	68.00	102.00					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	1.13	1.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	191	0		29	10	S5768_191_0	3	Non-Preferred Drug	4	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											66.33	50	50	50				57.59	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	191	0		29	10	S5768_191_0	3	Non-Preferred Drug	4	100100	1	1	4	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31											78.28	50	50	50				43.41	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5768	191	0		29	10	S5768_191_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	192	0		29	10	S5768_192_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	192	0		29	10	S5768_192_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	192	0		29	10	S5768_192_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	192	0		29	10	S5768_192_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	192	0		29	10	S5768_192_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								34.00	68.00	102.00					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	1.13	1.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	192	0		29	10	S5768_192_0	3	Non-Preferred Drug	4	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											64.44	50	50	50				57.55	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	192	0		29	10	S5768_192_0	3	Non-Preferred Drug	4	100100	1	1	4	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31											75.40	50	50	50				41.01	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5768	192	0		29	10	S5768_192_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	193	0		29	10	S5768_193_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	193	0		29	10	S5768_193_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	193	0		29	10	S5768_193_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	193	0		29	10	S5768_193_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	193	0		29	10	S5768_193_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								34.00	68.00	102.00					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	1.13	1.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	193	0		29	10	S5768_193_0	3	Non-Preferred Drug	4	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											64.95	50	50	50				54.90	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	193	0		29	10	S5768_193_0	3	Non-Preferred Drug	4	100100	1	1	4	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31											62.15	50	50	50				37.80	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5768	193	0		29	10	S5768_193_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	194	0		29	10	S5768_194_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	194	0		29	10	S5768_194_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	194	0		29	10	S5768_194_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	194	0		29	10	S5768_194_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	194	0		29	10	S5768_194_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								34.00	68.00	102.00					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	1.13	1.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	194	0		29	10	S5768_194_0	3	Non-Preferred Drug	4	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											67.29	50	50	50				59.64	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	194	0		29	10	S5768_194_0	3	Non-Preferred Drug	4	100100	1	1	4	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31											71.24	50	50	50				47.07	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5768	194	0		29	10	S5768_194_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	195	0		29	10	S5768_195_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	195	0		29	10	S5768_195_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	195	0		29	10	S5768_195_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	195	0		29	10	S5768_195_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	195	0		29	10	S5768_195_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								34.00	68.00	102.00					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	1.13	1.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	195	0		29	10	S5768_195_0	3	Non-Preferred Drug	4	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											64.87	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												
S5768	195	0		29	10	S5768_195_0	3	Non-Preferred Drug	4	100100	1	1	4	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31											66.28	50	50	50				48.79	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5768	195	0		29	10	S5768_195_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	196	0		29	10	S5768_196_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	196	0		29	10	S5768_196_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	196	0		29	10	S5768_196_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	196	0		29	10	S5768_196_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	196	0		29	10	S5768_196_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								34.00	68.00	102.00					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	1.13	1.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	196	0		29	10	S5768_196_0	3	Non-Preferred Drug	4	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											66.38	50	50	50				57.42	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	196	0		29	10	S5768_196_0	3	Non-Preferred Drug	4	100100	1	1	4	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31											78.15	50	50	50				39.54	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5768	196	0		29	10	S5768_196_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	197	0		29	10	S5768_197_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	197	0		29	10	S5768_197_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	197	0		29	10	S5768_197_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	197	0		29	10	S5768_197_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	197	0		29	10	S5768_197_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								46.00	92.00	138.00					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	1.53	1.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	197	0		29	10	S5768_197_0	3	Non-Preferred Drug	4	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											77.12	50	50	50				55.54	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	197	0		29	10	S5768_197_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	198	0		29	10	S5768_198_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	198	0		29	10	S5768_198_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	198	0		29	10	S5768_198_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	198	0		29	10	S5768_198_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	198	0		29	10	S5768_198_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	198	0		29	10	S5768_198_0	3	Non-Preferred Drug	4	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											89.08	50	50	50				68.47	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	198	0		29	10	S5768_198_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	199	0		29	10	S5768_199_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	199	0		29	10	S5768_199_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					1.00	2.00	3.00											10.00	20.00	30.00				1.00	2.00	3.00					10.00			10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	199	0		29	10	S5768_199_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	199	0		29	10	S5768_199_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	199	0		29	10	S5768_199_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								34.00	68.00	102.00					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	1.13	1.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	199	0		29	10	S5768_199_0	3	Non-Preferred Drug	4	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											71.58	50	50	50				64.13	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	199	0		29	10	S5768_199_0	3	Non-Preferred Drug	4	100100	1	1	4	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31											84.04	50	50	50				54.80	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5768	199	0		29	10	S5768_199_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	200	0		29	10	S5768_200_0	3	Preferred Generic	4	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	200	0		29	10	S5768_200_0	3	Preferred Generic	4	001000	1	2	1	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								10.00	20.00	30.00					2.00	4.00	6.00											10.00	20.00	30.00				2.00	4.00	6.00					10.00			10.00			0.33	0.07		0.33	0.07	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	200	0		29	10	S5768_200_0	3	Generic	4	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	200	0		29	10	S5768_200_0	3	Generic	4	010000	1	2	2	3		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					5.00	10.00	15.00											20.00	40.00	60.00				5.00	10.00	15.00					20.00			20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5768	200	0		29	10	S5768_200_0	3	Preferred Brand	4	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								47.00	94.00	141.00					47.00	94.00	141.00											47.00	94.00	141.00				47.00	94.00	141.00					47.00			47.00			1.57	1.57		1.57	1.57	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	200	0		29	10	S5768_200_0	3	Non-Preferred Drug	4	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											73.80	50	50	50				61.37	50	50	50										50	50	50				50	50	50				50		50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5768	200	0		29	10	S5768_200_0	3	Specialty Tier	4	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	33						1.00	33												33						33						33		33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5795	002	0		29	10	S5795_002_0	5	Preferred Generic	4	001000	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								7.00		14.00					2.00		4.00					2.00		4.00																7.00				2.00			0.23	0.07	0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5795	002	0		29	10	S5795_002_0	5	Preferred Generic	4	001000	1	2	1	3		110	01	110		1				30		90	1	2	30		90				30		31								7.00		14.00					2.00		4.00					2.00		4.00																7.00				2.00			0.23	0.07	0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5795	002	0		29	10	S5795_002_0	5	Generic	4	010000	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								15.00		37.50					10.00		25.00					10.00		25.00																15.00				10.00			0.50	0.33	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5795	002	0		29	10	S5795_002_0	5	Generic	4	010000	1	2	2	3		110	01	110		1				30		90	1	2	30		90				30		31								15.00		37.50					10.00		25.00					10.00		25.00																15.00				10.00			0.50	0.33	0.33			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5795	002	0		29	10	S5795_002_0	5	Preferred Brand	4	000001	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		117.50					42.00		105.00					42.00		105.00																47.00				42.00			1.57	1.40	1.40			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5795	002	0		29	10	S5795_002_0	5	Non-Preferred Brand	4	110000	1	2	4	1		110	01	110		1				30		90	1	2	30		90				30		31								100.00		250.00					90.00		225.00					90.00		225.00																100.00				90.00			3.33	3.00	3.00			2.90	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5795	002	0		29	10	S5795_002_0	5	Specialty Tier	4	010010	1	1	5	1		110	01	110		1				30		90	1	2	30		90				30		31											1039.20	33		33				583.28	33		33				33		33															33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5795	003	0		29	10	S5795_003_0	5	Preferred Generic	3	001000	1	2	1	1		110	01	110		1				30		90	1	2	30		90				30		31								10.00		25.00					4.00		10.00					4.00		10.00																10.00				4.00			0.33	0.13	0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5795	003	0		29	10	S5795_003_0	5	Generic	3	010000	1	2	2	1		110	01	110		1				30		90	1	2	30		90				30		31								20.00		50.00					15.00		37.50					15.00		37.50																20.00				15.00			0.67	0.50	0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5795	003	0		29	10	S5795_003_0	5	Preferred Brand	3	000001	1	2	3	1		110	01	110		1				30		90	1	2	30		90				30		31								47.00		117.50					42.00		105.00					42.00		105.00																47.00				42.00			1.57	1.40	1.40			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5795	003	0		29	10	S5795_003_0	5	Non-Preferred Brand	3	110000	1	2	4	1		110	01	110		1				30		90	1	2	30		90				30		31								100.00		250.00					95.00		237.50					95.00		237.50																100.00				95.00			3.33	3.17	3.17			3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5795	003	0		29	10	S5795_003_0	5	Specialty Tier	3	010010	1	1	5	1		110	01	110		1				30		90	1	2	30		90				30		31											945.81	25		25				459.38	25		25				25		25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5805	001	0		29	10	S5805_001_0	2	Preferred Generic	4	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								6.00		18.00					3.00		9.00													18.00						0.00				6.00				6.00			0.20	0.10				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5805	001	0		29	10	S5805_001_0	2	Generic	4	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								12.00		36.00					8.00		24.00													36.00						0.00				12.00				12.00			0.40	0.26				0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5805	001	0		29	10	S5805_001_0	2	Preferred Brand	4	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								45.00		135.00					35.00		105.00													135.00						90.00				45.00				45.00			1.50	1.16				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5805	001	0		29	10	S5805_001_0	2	Preferred Brand	4	010001	1	2	3	3		110	01		100	1				30		90	1	2						90	30		31								45.00		135.00					35.00		105.00													135.00						90.00				45.00				45.00			1.50	1.16				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5805	001	0		29	10	S5805_001_0	2	Non-Preferred Drug	4	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											105.00	41		41				90.00	35		35												41						35			41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5805	001	0		29	10	S5805_001_0	2	Non-Preferred Drug	4	100100	1	1	4	3		110	01		100	1				30		90	1	2						90	30		31											82.00	31		31				79.00	30		30												31						30			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5805	001	0		29	10	S5805_001_0	2	Specialty Tier	4	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											966.00	33		33				966.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5805	001	0		29	10	S5805_001_0	2	Specialty Tier	4	010010	1	1	5	3		110	01		100	1				30		90	1	2						90	30		31											251.00	33		33				251.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5810	035	0		29	10	S5810_035_0	4	Preferred Generic	3	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7.00	14.00	21.00					1.00	2.00	3.00											7.00	14.00	21.00				1.00	2.00	3.00					7.00			7.00			0.23	0.03		0.23	0.03	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	035	0		29	10	S5810_035_0	4	Generic	3	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	6.00											15.00	30.00	45.00				2.00	4.00	6.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	035	0		29	10	S5810_035_0	4	Preferred Brand	3	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								30.00	60.00	90.00					30.00	60.00	90.00											30.00	60.00	90.00				30.00	60.00	90.00					30.00			30.00			1.00	1.00		1.00	1.00	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	035	0		29	10	S5810_035_0	4	Non-Preferred Drug	3	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											55.03	35	35	35				42.97	35	35	35										35	35	35				35	35	35				35		35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	035	0		29	10	S5810_035_0	4	Specialty Tier	3	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	25						1.00	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	036	0		29	10	S5810_036_0	4	Preferred Generic	3	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7.00	14.00	21.00					1.00	2.00	3.00											7.00	14.00	21.00				1.00	2.00	3.00					7.00			7.00			0.23	0.03		0.23	0.03	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	036	0		29	10	S5810_036_0	4	Generic	3	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	6.00											15.00	30.00	45.00				2.00	4.00	6.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	036	0		29	10	S5810_036_0	4	Preferred Brand	3	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								30.00	60.00	90.00					30.00	60.00	90.00											30.00	60.00	90.00				30.00	60.00	90.00					30.00			30.00			1.00	1.00		1.00	1.00	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	036	0		29	10	S5810_036_0	4	Non-Preferred Drug	3	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											55.82	35	35	35				47.79	35	35	35										35	35	35				35	35	35				35		35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	036	0		29	10	S5810_036_0	4	Specialty Tier	3	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	25						1.00	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	037	0		29	10	S5810_037_0	4	Preferred Generic	3	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7.00	14.00	21.00					1.00	2.00	3.00											7.00	14.00	21.00				1.00	2.00	3.00					7.00			7.00			0.23	0.03		0.23	0.03	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	037	0		29	10	S5810_037_0	4	Generic	3	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	6.00											15.00	30.00	45.00				2.00	4.00	6.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	037	0		29	10	S5810_037_0	4	Preferred Brand	3	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								30.00	60.00	90.00					30.00	60.00	90.00											30.00	60.00	90.00				30.00	60.00	90.00					30.00			30.00			1.00	1.00		1.00	1.00	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	037	0		29	10	S5810_037_0	4	Non-Preferred Drug	3	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											66.15	35	35	35				56.87	35	35	35										35	35	35				35	35	35				35		35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	037	0		29	10	S5810_037_0	4	Specialty Tier	3	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	25						1.00	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	038	0		29	10	S5810_038_0	4	Preferred Generic	3	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7.00	14.00	21.00					1.00	2.00	3.00											7.00	14.00	21.00				1.00	2.00	3.00					7.00			7.00			0.23	0.03		0.23	0.03	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	038	0		29	10	S5810_038_0	4	Generic	3	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	6.00											15.00	30.00	45.00				2.00	4.00	6.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	038	0		29	10	S5810_038_0	4	Preferred Brand	3	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								30.00	60.00	90.00					30.00	60.00	90.00											30.00	60.00	90.00				30.00	60.00	90.00					30.00			30.00			1.00	1.00		1.00	1.00	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	038	0		29	10	S5810_038_0	4	Non-Preferred Drug	3	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											54.43	35	35	35				48.41	35	35	35										35	35	35				35	35	35				35		35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	038	0		29	10	S5810_038_0	4	Specialty Tier	3	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	25						1.00	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	039	0		29	10	S5810_039_0	4	Preferred Generic	3	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7.00	14.00	21.00					1.00	2.00	3.00											7.00	14.00	21.00				1.00	2.00	3.00					7.00			7.00			0.23	0.03		0.23	0.03	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	039	0		29	10	S5810_039_0	4	Generic	3	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	6.00											15.00	30.00	45.00				2.00	4.00	6.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	039	0		29	10	S5810_039_0	4	Preferred Brand	3	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								30.00	60.00	90.00					30.00	60.00	90.00											30.00	60.00	90.00				30.00	60.00	90.00					30.00			30.00			1.00	1.00		1.00	1.00	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	039	0		29	10	S5810_039_0	4	Non-Preferred Drug	3	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											60.24	35	35	35				53.58	35	35	35										35	35	35				35	35	35				35		35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	039	0		29	10	S5810_039_0	4	Specialty Tier	3	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	25						1.00	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	040	0		29	10	S5810_040_0	4	Preferred Generic	3	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7.00	14.00	21.00					1.00	2.00	3.00											7.00	14.00	21.00				1.00	2.00	3.00					7.00			7.00			0.23	0.03		0.23	0.03	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	040	0		29	10	S5810_040_0	4	Generic	3	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	6.00											15.00	30.00	45.00				2.00	4.00	6.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	040	0		29	10	S5810_040_0	4	Preferred Brand	3	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								30.00	60.00	90.00					30.00	60.00	90.00											30.00	60.00	90.00				30.00	60.00	90.00					30.00			30.00			1.00	1.00		1.00	1.00	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	040	0		29	10	S5810_040_0	4	Non-Preferred Drug	3	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											53.46	35	35	35				43.87	35	35	35										35	35	35				35	35	35				35		35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	040	0		29	10	S5810_040_0	4	Specialty Tier	3	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	25						1.00	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	041	0		29	10	S5810_041_0	4	Preferred Generic	3	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7.00	14.00	21.00					1.00	2.00	3.00											7.00	14.00	21.00				1.00	2.00	3.00					7.00			7.00			0.23	0.03		0.23	0.03	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	041	0		29	10	S5810_041_0	4	Generic	3	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	6.00											15.00	30.00	45.00				2.00	4.00	6.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	041	0		29	10	S5810_041_0	4	Preferred Brand	3	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								30.00	60.00	90.00					30.00	60.00	90.00											30.00	60.00	90.00				30.00	60.00	90.00					30.00			30.00			1.00	1.00		1.00	1.00	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	041	0		29	10	S5810_041_0	4	Non-Preferred Drug	3	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											57.28	35	35	35				48.86	35	35	35										35	35	35				35	35	35				35		35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	041	0		29	10	S5810_041_0	4	Specialty Tier	3	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	25						1.00	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	042	0		29	10	S5810_042_0	4	Preferred Generic	3	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7.00	14.00	21.00					1.00	2.00	3.00											7.00	14.00	21.00				1.00	2.00	3.00					7.00			7.00			0.23	0.03		0.23	0.03	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	042	0		29	10	S5810_042_0	4	Generic	3	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	6.00											15.00	30.00	45.00				2.00	4.00	6.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	042	0		29	10	S5810_042_0	4	Preferred Brand	3	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								30.00	60.00	90.00					30.00	60.00	90.00											30.00	60.00	90.00				30.00	60.00	90.00					30.00			30.00			1.00	1.00		1.00	1.00	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	042	0		29	10	S5810_042_0	4	Non-Preferred Drug	3	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											63.16	35	35	35				55.87	35	35	35										35	35	35				35	35	35				35		35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	042	0		29	10	S5810_042_0	4	Specialty Tier	3	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	25						1.00	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	043	0		29	10	S5810_043_0	4	Preferred Generic	3	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7.00	14.00	21.00					1.00	2.00	3.00											7.00	14.00	21.00				1.00	2.00	3.00					7.00			7.00			0.23	0.03		0.23	0.03	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	043	0		29	10	S5810_043_0	4	Generic	3	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	6.00											15.00	30.00	45.00				2.00	4.00	6.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	043	0		29	10	S5810_043_0	4	Preferred Brand	3	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								30.00	60.00	90.00					30.00	60.00	90.00											30.00	60.00	90.00				30.00	60.00	90.00					30.00			30.00			1.00	1.00		1.00	1.00	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	043	0		29	10	S5810_043_0	4	Non-Preferred Drug	3	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											61.93	35	35	35				51.65	35	35	35										35	35	35				35	35	35				35		35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	043	0		29	10	S5810_043_0	4	Specialty Tier	3	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	25						1.00	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	044	0		29	10	S5810_044_0	4	Preferred Generic	3	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7.00	14.00	21.00					1.00	2.00	3.00											7.00	14.00	21.00				1.00	2.00	3.00					7.00			7.00			0.23	0.03		0.23	0.03	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	044	0		29	10	S5810_044_0	4	Generic	3	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	6.00											15.00	30.00	45.00				2.00	4.00	6.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	044	0		29	10	S5810_044_0	4	Preferred Brand	3	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								30.00	60.00	90.00					30.00	60.00	90.00											30.00	60.00	90.00				30.00	60.00	90.00					30.00			30.00			1.00	1.00		1.00	1.00	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	044	0		29	10	S5810_044_0	4	Non-Preferred Drug	3	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											59.45	35	35	35				49.13	35	35	35										35	35	35				35	35	35				35		35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	044	0		29	10	S5810_044_0	4	Specialty Tier	3	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	25						1.00	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	045	0		29	10	S5810_045_0	4	Preferred Generic	3	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7.00	14.00	21.00					1.00	2.00	3.00											7.00	14.00	21.00				1.00	2.00	3.00					7.00			7.00			0.23	0.03		0.23	0.03	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	045	0		29	10	S5810_045_0	4	Generic	3	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	6.00											15.00	30.00	45.00				2.00	4.00	6.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	045	0		29	10	S5810_045_0	4	Preferred Brand	3	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								35.00	70.00	105.00					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	1.17	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	045	0		29	10	S5810_045_0	4	Non-Preferred Drug	3	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											65.44	42	42	42				50.62	42	42	42										42	42	42				42	42	42				42		42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	045	0		29	10	S5810_045_0	4	Specialty Tier	3	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	25						1.00	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	046	0		29	10	S5810_046_0	4	Preferred Generic	3	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7.00	14.00	21.00					1.00	2.00	3.00											7.00	14.00	21.00				1.00	2.00	3.00					7.00			7.00			0.23	0.03		0.23	0.03	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	046	0		29	10	S5810_046_0	4	Generic	3	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	6.00											15.00	30.00	45.00				2.00	4.00	6.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	046	0		29	10	S5810_046_0	4	Preferred Brand	3	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								30.00	60.00	90.00					30.00	60.00	90.00											30.00	60.00	90.00				30.00	60.00	90.00					30.00			30.00			1.00	1.00		1.00	1.00	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	046	0		29	10	S5810_046_0	4	Non-Preferred Drug	3	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											54.42	35	35	35				42.54	35	35	35										35	35	35				35	35	35				35		35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	046	0		29	10	S5810_046_0	4	Specialty Tier	3	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	25						1.00	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	047	0		29	10	S5810_047_0	4	Preferred Generic	3	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7.00	14.00	21.00					1.00	2.00	3.00											7.00	14.00	21.00				1.00	2.00	3.00					7.00			7.00			0.23	0.03		0.23	0.03	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	047	0		29	10	S5810_047_0	4	Generic	3	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	6.00											15.00	30.00	45.00				2.00	4.00	6.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	047	0		29	10	S5810_047_0	4	Preferred Brand	3	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								30.00	60.00	90.00					30.00	60.00	90.00											30.00	60.00	90.00				30.00	60.00	90.00					30.00			30.00			1.00	1.00		1.00	1.00	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	047	0		29	10	S5810_047_0	4	Non-Preferred Drug	3	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											63.00	35	35	35				53.75	35	35	35										35	35	35				35	35	35				35		35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	047	0		29	10	S5810_047_0	4	Specialty Tier	3	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	25						1.00	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	048	0		29	10	S5810_048_0	4	Preferred Generic	3	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7.00	14.00	21.00					1.00	2.00	3.00											7.00	14.00	21.00				1.00	2.00	3.00					7.00			7.00			0.23	0.03		0.23	0.03	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	048	0		29	10	S5810_048_0	4	Generic	3	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	6.00											15.00	30.00	45.00				2.00	4.00	6.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	048	0		29	10	S5810_048_0	4	Preferred Brand	3	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								30.00	60.00	90.00					30.00	60.00	90.00											30.00	60.00	90.00				30.00	60.00	90.00					30.00			30.00			1.00	1.00		1.00	1.00	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	048	0		29	10	S5810_048_0	4	Non-Preferred Drug	3	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											62.40	35	35	35				51.05	35	35	35										35	35	35				35	35	35				35		35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	048	0		29	10	S5810_048_0	4	Specialty Tier	3	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	25						1.00	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	049	0		29	10	S5810_049_0	4	Preferred Generic	3	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7.00	14.00	21.00					1.00	2.00	3.00											7.00	14.00	21.00				1.00	2.00	3.00					7.00			7.00			0.23	0.03		0.23	0.03	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	049	0		29	10	S5810_049_0	4	Generic	3	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	6.00											15.00	30.00	45.00				2.00	4.00	6.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	049	0		29	10	S5810_049_0	4	Preferred Brand	3	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								30.00	60.00	90.00					30.00	60.00	90.00											30.00	60.00	90.00				30.00	60.00	90.00					30.00			30.00			1.00	1.00		1.00	1.00	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	049	0		29	10	S5810_049_0	4	Non-Preferred Drug	3	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											59.87	35	35	35				50.91	35	35	35										35	35	35				35	35	35				35		35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	049	0		29	10	S5810_049_0	4	Specialty Tier	3	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	25						1.00	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	050	0		29	10	S5810_050_0	4	Preferred Generic	3	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7.00	14.00	21.00					1.00	2.00	3.00											7.00	14.00	21.00				1.00	2.00	3.00					7.00			7.00			0.23	0.03		0.23	0.03	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	050	0		29	10	S5810_050_0	4	Generic	3	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	6.00											15.00	30.00	45.00				2.00	4.00	6.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	050	0		29	10	S5810_050_0	4	Preferred Brand	3	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								30.00	60.00	90.00					30.00	60.00	90.00											30.00	60.00	90.00				30.00	60.00	90.00					30.00			30.00			1.00	1.00		1.00	1.00	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	050	0		29	10	S5810_050_0	4	Non-Preferred Drug	3	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											57.64	35	35	35				46.90	35	35	35										35	35	35				35	35	35				35		35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	050	0		29	10	S5810_050_0	4	Specialty Tier	3	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	25						1.00	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	051	0		29	10	S5810_051_0	4	Preferred Generic	3	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7.00	14.00	21.00					1.00	2.00	3.00											7.00	14.00	21.00				1.00	2.00	3.00					7.00			7.00			0.23	0.03		0.23	0.03	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	051	0		29	10	S5810_051_0	4	Generic	3	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	6.00											15.00	30.00	45.00				2.00	4.00	6.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	051	0		29	10	S5810_051_0	4	Preferred Brand	3	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								30.00	60.00	90.00					30.00	60.00	90.00											30.00	60.00	90.00				30.00	60.00	90.00					30.00			30.00			1.00	1.00		1.00	1.00	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	051	0		29	10	S5810_051_0	4	Non-Preferred Drug	3	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											66.20	39	39	39				50.02	39	39	39										39	39	39				39	39	39				39		39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	051	0		29	10	S5810_051_0	4	Specialty Tier	3	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	25						1.00	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	052	0		29	10	S5810_052_0	4	Preferred Generic	3	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7.00	14.00	21.00					1.00	2.00	3.00											7.00	14.00	21.00				1.00	2.00	3.00					7.00			7.00			0.23	0.03		0.23	0.03	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	052	0		29	10	S5810_052_0	4	Generic	3	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	6.00											15.00	30.00	45.00				2.00	4.00	6.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	052	0		29	10	S5810_052_0	4	Preferred Brand	3	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								30.00	60.00	90.00					30.00	60.00	90.00											30.00	60.00	90.00				30.00	60.00	90.00					30.00			30.00			1.00	1.00		1.00	1.00	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	052	0		29	10	S5810_052_0	4	Non-Preferred Drug	3	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											65.17	35	35	35				54.05	35	35	35										35	35	35				35	35	35				35		35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	052	0		29	10	S5810_052_0	4	Specialty Tier	3	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	25						1.00	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	053	0		29	10	S5810_053_0	4	Preferred Generic	3	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7.00	14.00	21.00					1.00	2.00	3.00											7.00	14.00	21.00				1.00	2.00	3.00					7.00			7.00			0.23	0.03		0.23	0.03	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	053	0		29	10	S5810_053_0	4	Generic	3	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	6.00											15.00	30.00	45.00				2.00	4.00	6.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	053	0		29	10	S5810_053_0	4	Preferred Brand	3	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								30.00	60.00	90.00					30.00	60.00	90.00											30.00	60.00	90.00				30.00	60.00	90.00					30.00			30.00			1.00	1.00		1.00	1.00	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	053	0		29	10	S5810_053_0	4	Non-Preferred Drug	3	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											56.26	35	35	35				47.34	35	35	35										35	35	35				35	35	35				35		35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	053	0		29	10	S5810_053_0	4	Specialty Tier	3	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	25						1.00	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	054	0		29	10	S5810_054_0	4	Preferred Generic	3	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7.00	14.00	21.00					1.00	2.00	3.00											7.00	14.00	21.00				1.00	2.00	3.00					7.00			7.00			0.23	0.03		0.23	0.03	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	054	0		29	10	S5810_054_0	4	Generic	3	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	6.00											15.00	30.00	45.00				2.00	4.00	6.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	054	0		29	10	S5810_054_0	4	Preferred Brand	3	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								30.00	60.00	90.00					30.00	60.00	90.00											30.00	60.00	90.00				30.00	60.00	90.00					30.00			30.00			1.00	1.00		1.00	1.00	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	054	0		29	10	S5810_054_0	4	Non-Preferred Drug	3	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											59.85	35	35	35				49.68	35	35	35										35	35	35				35	35	35				35		35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	054	0		29	10	S5810_054_0	4	Specialty Tier	3	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	25						1.00	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	055	0		29	10	S5810_055_0	4	Preferred Generic	3	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7.00	14.00	21.00					1.00	2.00	3.00											7.00	14.00	21.00				1.00	2.00	3.00					7.00			7.00			0.23	0.03		0.23	0.03	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	055	0		29	10	S5810_055_0	4	Generic	3	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	6.00											15.00	30.00	45.00				2.00	4.00	6.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	055	0		29	10	S5810_055_0	4	Preferred Brand	3	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								30.00	60.00	90.00					30.00	60.00	90.00											30.00	60.00	90.00				30.00	60.00	90.00					30.00			30.00			1.00	1.00		1.00	1.00	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	055	0		29	10	S5810_055_0	4	Non-Preferred Drug	3	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											57.54	35	35	35				48.00	35	35	35										35	35	35				35	35	35				35		35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	055	0		29	10	S5810_055_0	4	Specialty Tier	3	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	25						1.00	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	056	0		29	10	S5810_056_0	4	Preferred Generic	3	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7.00	14.00	21.00					1.00	2.00	3.00											7.00	14.00	21.00				1.00	2.00	3.00					7.00			7.00			0.23	0.03		0.23	0.03	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	056	0		29	10	S5810_056_0	4	Generic	3	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	6.00											15.00	30.00	45.00				2.00	4.00	6.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	056	0		29	10	S5810_056_0	4	Preferred Brand	3	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								30.00	60.00	90.00					30.00	60.00	90.00											30.00	60.00	90.00				30.00	60.00	90.00					30.00			30.00			1.00	1.00		1.00	1.00	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	056	0		29	10	S5810_056_0	4	Non-Preferred Drug	3	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											67.61	38	38	38				56.78	38	38	38										38	38	38				38	38	38				38		38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	056	0		29	10	S5810_056_0	4	Specialty Tier	3	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	25						1.00	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	057	0		29	10	S5810_057_0	4	Preferred Generic	3	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7.00	14.00	21.00					1.00	2.00	3.00											7.00	14.00	21.00				1.00	2.00	3.00					7.00			7.00			0.23	0.03		0.23	0.03	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	057	0		29	10	S5810_057_0	4	Generic	3	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	6.00											15.00	30.00	45.00				2.00	4.00	6.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	057	0		29	10	S5810_057_0	4	Preferred Brand	3	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								30.00	60.00	90.00					30.00	60.00	90.00											30.00	60.00	90.00				30.00	60.00	90.00					30.00			30.00			1.00	1.00		1.00	1.00	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	057	0		29	10	S5810_057_0	4	Non-Preferred Drug	3	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											57.44	35	35	35				46.39	35	35	35										35	35	35				35	35	35				35		35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	057	0		29	10	S5810_057_0	4	Specialty Tier	3	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	25						1.00	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	058	0		29	10	S5810_058_0	4	Preferred Generic	3	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7.00	14.00	21.00					1.00	2.00	3.00											7.00	14.00	21.00				1.00	2.00	3.00					7.00			7.00			0.23	0.03		0.23	0.03	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	058	0		29	10	S5810_058_0	4	Generic	3	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	6.00											15.00	30.00	45.00				2.00	4.00	6.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	058	0		29	10	S5810_058_0	4	Preferred Brand	3	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								30.00	60.00	90.00					30.00	60.00	90.00											30.00	60.00	90.00				30.00	60.00	90.00					30.00			30.00			1.00	1.00		1.00	1.00	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	058	0		29	10	S5810_058_0	4	Non-Preferred Drug	3	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											63.68	35	35	35				49.29	35	35	35										35	35	35				35	35	35				35		35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	058	0		29	10	S5810_058_0	4	Specialty Tier	3	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	25						1.00	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	059	0		29	10	S5810_059_0	4	Preferred Generic	3	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7.00	14.00	21.00					1.00	2.00	3.00											7.00	14.00	21.00				1.00	2.00	3.00					7.00			7.00			0.23	0.03		0.23	0.03	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	059	0		29	10	S5810_059_0	4	Generic	3	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	6.00											15.00	30.00	45.00				2.00	4.00	6.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	059	0		29	10	S5810_059_0	4	Preferred Brand	3	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								30.00	60.00	90.00					30.00	60.00	90.00											30.00	60.00	90.00				30.00	60.00	90.00					30.00			30.00			1.00	1.00		1.00	1.00	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	059	0		29	10	S5810_059_0	4	Non-Preferred Drug	3	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											60.52	35	35	35				46.71	35	35	35										35	35	35				35	35	35				35		35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	059	0		29	10	S5810_059_0	4	Specialty Tier	3	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	25						1.00	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	060	0		29	10	S5810_060_0	4	Preferred Generic	3	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7.00	14.00	21.00					1.00	2.00	3.00											7.00	14.00	21.00				1.00	2.00	3.00					7.00			7.00			0.23	0.03		0.23	0.03	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	060	0		29	10	S5810_060_0	4	Generic	3	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	060	0		29	10	S5810_060_0	4	Preferred Brand	3	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								35.00	70.00	105.00					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	1.17	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	060	0		29	10	S5810_060_0	4	Non-Preferred Drug	3	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											66.42	39	39	39				54.55	39	39	39										39	39	39				39	39	39				39		39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	060	0		29	10	S5810_060_0	4	Specialty Tier	3	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	25						1.00	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	061	0		29	10	S5810_061_0	4	Preferred Generic	3	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7.00	14.00	21.00					1.00	2.00	3.00											7.00	14.00	21.00				1.00	2.00	3.00					7.00			7.00			0.23	0.03		0.23	0.03	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	061	0		29	10	S5810_061_0	4	Generic	3	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	061	0		29	10	S5810_061_0	4	Preferred Brand	3	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								35.00	70.00	105.00					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	1.17	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	061	0		29	10	S5810_061_0	4	Non-Preferred Drug	3	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											63.19	34	34	34				47.39	34	34	34										34	34	34				34	34	34				34		34								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	061	0		29	10	S5810_061_0	4	Specialty Tier	3	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	25						1.00	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	062	0		29	10	S5810_062_0	4	Preferred Generic	3	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7.00	14.00	21.00					1.00	2.00	3.00											7.00	14.00	21.00				1.00	2.00	3.00					7.00			7.00			0.23	0.03		0.23	0.03	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	062	0		29	10	S5810_062_0	4	Generic	3	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	062	0		29	10	S5810_062_0	4	Preferred Brand	3	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								35.00	70.00	105.00					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	1.17	1.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	062	0		29	10	S5810_062_0	4	Non-Preferred Drug	3	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											55.04	32	32	32				40.52	32	32	32										32	32	32				32	32	32				32		32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	062	0		29	10	S5810_062_0	4	Specialty Tier	3	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	25						1.00	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	063	0		29	10	S5810_063_0	4	Preferred Generic	3	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7.00	14.00	21.00					1.00	2.00	3.00											7.00	14.00	21.00				1.00	2.00	3.00					7.00			7.00			0.23	0.03		0.23	0.03	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	063	0		29	10	S5810_063_0	4	Generic	3	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	6.00											15.00	30.00	45.00				2.00	4.00	6.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	063	0		29	10	S5810_063_0	4	Preferred Brand	3	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								30.00	60.00	90.00					30.00	60.00	90.00											30.00	60.00	90.00				30.00	60.00	90.00					30.00			30.00			1.00	1.00		1.00	1.00	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	063	0		29	10	S5810_063_0	4	Non-Preferred Drug	3	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											70.08	44	44	44				57.61	44	44	44										44	44	44				44	44	44				44		44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	063	0		29	10	S5810_063_0	4	Specialty Tier	3	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	25						1.00	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	064	0		29	10	S5810_064_0	4	Preferred Generic	3	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7.00	14.00	21.00					1.00	2.00	3.00											7.00	14.00	21.00				1.00	2.00	3.00					7.00			7.00			0.23	0.03		0.23	0.03	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	064	0		29	10	S5810_064_0	4	Generic	3	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	6.00											15.00	30.00	45.00				2.00	4.00	6.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	064	0		29	10	S5810_064_0	4	Preferred Brand	3	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								30.00	60.00	90.00					30.00	60.00	90.00											30.00	60.00	90.00				30.00	60.00	90.00					30.00			30.00			1.00	1.00		1.00	1.00	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	064	0		29	10	S5810_064_0	4	Non-Preferred Drug	3	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											67.92	39	39	39				51.42	39	39	39										39	39	39				39	39	39				39		39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	064	0		29	10	S5810_064_0	4	Specialty Tier	3	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	25						1.00	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	065	0		29	10	S5810_065_0	4	Preferred Generic	3	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7.00	14.00	21.00					1.00	2.00	3.00											7.00	14.00	21.00				1.00	2.00	3.00					7.00			7.00			0.23	0.03		0.23	0.03	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	065	0		29	10	S5810_065_0	4	Generic	3	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	6.00											15.00	30.00	45.00				2.00	4.00	6.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	065	0		29	10	S5810_065_0	4	Preferred Brand	3	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								30.00	60.00	90.00					30.00	60.00	90.00											30.00	60.00	90.00				30.00	60.00	90.00					30.00			30.00			1.00	1.00		1.00	1.00	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	065	0		29	10	S5810_065_0	4	Non-Preferred Drug	3	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											64.51	35	35	35				51.75	35	35	35										35	35	35				35	35	35				35		35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	065	0		29	10	S5810_065_0	4	Specialty Tier	3	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	25						1.00	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	066	0		29	10	S5810_066_0	4	Preferred Generic	3	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7.00	14.00	21.00					1.00	2.00	3.00											7.00	14.00	21.00				1.00	2.00	3.00					7.00			7.00			0.23	0.03		0.23	0.03	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	066	0		29	10	S5810_066_0	4	Generic	3	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	6.00											15.00	30.00	45.00				2.00	4.00	6.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	066	0		29	10	S5810_066_0	4	Preferred Brand	3	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								30.00	60.00	90.00					30.00	60.00	90.00											30.00	60.00	90.00				30.00	60.00	90.00					30.00			30.00			1.00	1.00		1.00	1.00	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	066	0		29	10	S5810_066_0	4	Non-Preferred Drug	3	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											70.24	38	38	38				59.76	38	38	38										38	38	38				38	38	38				38		38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	066	0		29	10	S5810_066_0	4	Specialty Tier	3	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	25						1.00	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	067	0		29	10	S5810_067_0	4	Preferred Generic	3	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7.00	14.00	21.00					1.00	2.00	3.00											7.00	14.00	21.00				1.00	2.00	3.00					7.00			7.00			0.23	0.03		0.23	0.03	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	067	0		29	10	S5810_067_0	4	Generic	3	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								15.00	30.00	45.00					2.00	4.00	6.00											15.00	30.00	45.00				2.00	4.00	6.00					15.00			15.00			0.50	0.07		0.50	0.07	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	067	0		29	10	S5810_067_0	4	Preferred Brand	3	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								30.00	60.00	90.00					30.00	60.00	90.00											30.00	60.00	90.00				30.00	60.00	90.00					30.00			30.00			1.00	1.00		1.00	1.00	0.97	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	067	0		29	10	S5810_067_0	4	Non-Preferred Drug	3	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											75.38	35	35	35				68.30	35	35	35										35	35	35				35	35	35				35		35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	067	0		29	10	S5810_067_0	4	Specialty Tier	3	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	25						1.00	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	068	0		29	10	S5810_068_0	4	Preferred Generic	3	001000	1	2	1	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								7.00	14.00	21.00					1.00	2.00	3.00											7.00	14.00	21.00				1.00	2.00	3.00					7.00			7.00			0.23	0.03		0.23	0.03	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	068	0		29	10	S5810_068_0	4	Generic	3	010000	1	2	2	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								20.00	40.00	60.00					2.00	4.00	6.00											20.00	40.00	60.00				2.00	4.00	6.00					20.00			20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	068	0		29	10	S5810_068_0	4	Preferred Brand	3	010001	1	2	3	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31								40.00	80.00	120.00					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	1.33	1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	068	0		29	10	S5810_068_0	4	Non-Preferred Drug	3	100100	1	1	4	1		111	10		111	1				30	60	90	1	2				30	60	90		10	31											69.35	38	38	38				46.83	38	38	38										38	38	38				38	38	38				38		38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5810	068	0		29	10	S5810_068_0	4	Specialty Tier	3	010010	1	1	5	1		010	10		010	1				30								30				10	31											1.00	25						1.00	25												25						25						25		25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	001	0		29	10	S5820_001_0	2	Preferred Generic	4	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					3.00		9.00													24.00						0.00				8.00				8.00			0.26	0.10				0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	001	0		29	10	S5820_001_0	2	Generic	4	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								12.00		36.00					8.00		24.00													36.00						0.00				12.00				12.00			0.40	0.26				0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	001	0		29	10	S5820_001_0	2	Preferred Brand	4	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					35.00		105.00													141.00						90.00				47.00				47.00			1.56	1.16				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	001	0		29	10	S5820_001_0	2	Non-Preferred Drug	4	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											98.00	44		44				89.00	40		40												44						40			44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	001	0		29	10	S5820_001_0	2	Specialty Tier	4	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											753.00	33		33				753.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	002	0		29	10	S5820_002_0	1	Preferred Generic	4	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								4.00		12.00					2.00		6.00													12.00						0.00				4.00				4.00			0.13	0.06				0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	002	0		29	10	S5820_002_0	1	Generic	4	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	002	0		29	10	S5820_002_0	1	Preferred Brand	4	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								46.00		138.00					36.00		108.00													138.00						93.00				46.00				46.00			1.53	1.20				1.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	002	0		29	10	S5820_002_0	1	Non-Preferred Drug	4	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											106.00	44		44				92.00	38		38												44						38			44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	002	0		29	10	S5820_002_0	1	Specialty Tier	4	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											850.00	33		33				850.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	003	0		29	10	S5820_003_0	1	Preferred Generic	4	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								7.00		21.00					4.00		12.00													21.00						0.00				7.00				7.00			0.23	0.13				0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	003	0		29	10	S5820_003_0	1	Generic	4	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								11.00		33.00					8.00		24.00													33.00						0.00				11.00				11.00			0.36	0.26				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	003	0		29	10	S5820_003_0	1	Preferred Brand	4	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								45.00		135.00					35.00		105.00													135.00						90.00				45.00				45.00			1.50	1.16				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	003	0		29	10	S5820_003_0	1	Non-Preferred Drug	4	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											106.00	44		44				91.00	38		38												44						38			44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	003	0		29	10	S5820_003_0	1	Specialty Tier	4	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											981.00	33		33				981.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	004	0		29	10	S5820_004_0	2	Preferred Generic	4	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					5.00		15.00													24.00						0.00				8.00				8.00			0.26	0.16				0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	004	0		29	10	S5820_004_0	2	Generic	4	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					10.00		30.00													60.00						0.00				20.00				20.00			0.66	0.33				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	004	0		29	10	S5820_004_0	2	Preferred Brand	4	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								46.00		138.00					35.00		105.00													138.00						90.00				46.00				46.00			1.53	1.16				1.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	004	0		29	10	S5820_004_0	2	Non-Preferred Drug	4	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											99.00	44		44				90.00	40		40												44						40			44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	004	0		29	10	S5820_004_0	2	Specialty Tier	4	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											927.00	33		33				927.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	005	0		29	10	S5820_005_0	1	Preferred Generic	4	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					5.00		15.00													30.00						0.00				10.00				10.00			0.33	0.16				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	005	0		29	10	S5820_005_0	1	Generic	4	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								14.00		42.00					8.00		24.00													42.00						0.00				14.00				14.00			0.46	0.26				0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	005	0		29	10	S5820_005_0	1	Preferred Brand	4	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								45.00		135.00					35.00		105.00													135.00						90.00				45.00				45.00			1.50	1.16				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	005	0		29	10	S5820_005_0	1	Non-Preferred Drug	4	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											108.00	50		50				87.00	40		40												50						40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	005	0		29	10	S5820_005_0	1	Specialty Tier	4	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											941.00	33		33				941.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	006	0		29	10	S5820_006_0	1	Preferred Generic	4	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								4.00		12.00					2.00		6.00													12.00						0.00				4.00				4.00			0.13	0.06				0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	006	0		29	10	S5820_006_0	1	Generic	4	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					15.00		45.00													60.00						0.00				20.00				20.00			0.66	0.50				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	006	0		29	10	S5820_006_0	1	Preferred Brand	4	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					36.00		108.00													141.00						93.00				47.00				47.00			1.56	1.20				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	006	0		29	10	S5820_006_0	1	Non-Preferred Drug	4	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											107.00	50		50				86.00	40		40												50						40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	006	0		29	10	S5820_006_0	1	Specialty Tier	4	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											847.00	33		33				847.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	007	0		29	10	S5820_007_0	1	Preferred Generic	4	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								7.00		21.00					3.00		9.00													21.00						0.00				7.00				7.00			0.23	0.10				0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	007	0		29	10	S5820_007_0	1	Generic	4	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								13.00		39.00					7.00		21.00													39.00						0.00				13.00				13.00			0.43	0.23				0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	007	0		29	10	S5820_007_0	1	Preferred Brand	4	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								45.00		135.00					35.00		105.00													135.00						90.00				45.00				45.00			1.50	1.16				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	007	0		29	10	S5820_007_0	1	Non-Preferred Drug	4	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											104.00	50		50				83.00	40		40												50						40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	007	0		29	10	S5820_007_0	1	Specialty Tier	4	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											919.00	33		33				919.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	008	0		29	10	S5820_008_0	1	Preferred Generic	4	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					5.00		15.00													30.00						0.00				10.00				10.00			0.33	0.16				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	008	0		29	10	S5820_008_0	1	Generic	4	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								14.00		42.00					8.00		24.00													42.00						0.00				14.00				14.00			0.46	0.26				0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	008	0		29	10	S5820_008_0	1	Preferred Brand	4	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								45.00		135.00					35.00		105.00													135.00						90.00				45.00				45.00			1.50	1.16				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	008	0		29	10	S5820_008_0	1	Non-Preferred Drug	4	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											100.00	50		50				80.00	40		40												50						40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	008	0		29	10	S5820_008_0	1	Specialty Tier	4	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											1003.00	33		33				1003.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	009	0		29	10	S5820_009_0	1	Preferred Generic	4	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					3.00		9.00													24.00						0.00				8.00				8.00			0.26	0.10				0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	009	0		29	10	S5820_009_0	1	Generic	4	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								13.00		39.00					8.00		24.00													39.00						0.00				13.00				13.00			0.43	0.26				0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	009	0		29	10	S5820_009_0	1	Preferred Brand	4	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								45.00		135.00					35.00		105.00													135.00						90.00				45.00				45.00			1.50	1.16				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	009	0		29	10	S5820_009_0	1	Non-Preferred Drug	4	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											100.00	50		50				80.00	40		40												50						40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	009	0		29	10	S5820_009_0	1	Specialty Tier	4	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											931.00	33		33				931.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	010	0		29	10	S5820_010_0	2	Preferred Generic	4	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								4.00		12.00					2.00		6.00													12.00						0.00				4.00				4.00			0.13	0.06				0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	010	0		29	10	S5820_010_0	2	Generic	4	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								20.00		60.00					15.00		45.00													60.00						0.00				20.00				20.00			0.66	0.50				0.64	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	010	0		29	10	S5820_010_0	2	Preferred Brand	4	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					36.00		108.00													141.00						93.00				47.00				47.00			1.56	1.20				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	010	0		29	10	S5820_010_0	2	Preferred Brand	4	010001	1	2	3	3		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					36.00		108.00													141.00						93.00				47.00				47.00			1.56	1.20				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5820	010	0		29	10	S5820_010_0	2	Non-Preferred Drug	4	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											107.00	50		50				86.00	40		40												50						40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	010	0		29	10	S5820_010_0	2	Non-Preferred Drug	4	100100	1	1	4	3		110	01		100	1				30		90	1	2						90	30		31											84.00	31		31				81.00	30		30												31						30			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5820	010	0		29	10	S5820_010_0	2	Specialty Tier	4	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											1013.00	33		33				1013.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	010	0		29	10	S5820_010_0	2	Specialty Tier	4	010010	1	1	5	3		110	01		100	1				30		90	1	2						90	30		31											365.00	33		33				365.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5820	011	0		29	10	S5820_011_0	1	Preferred Generic	4	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								6.00		18.00					3.00		9.00													18.00						0.00				6.00				6.00			0.20	0.10				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	011	0		29	10	S5820_011_0	1	Generic	4	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								12.00		36.00					7.00		21.00													36.00						0.00				12.00				12.00			0.40	0.23				0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	011	0		29	10	S5820_011_0	1	Preferred Brand	4	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								43.00		129.00					33.00		99.00													129.00						84.00				43.00				43.00			1.43	1.10				1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	011	0		29	10	S5820_011_0	1	Non-Preferred Drug	4	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											95.00	50		50				76.00	40		40												50						40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	011	0		29	10	S5820_011_0	1	Specialty Tier	4	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											913.00	33		33				913.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	012	0		29	10	S5820_012_0	1	Preferred Generic	4	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								9.00		27.00					4.00		12.00													27.00						0.00				9.00				9.00			0.30	0.13				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	012	0		29	10	S5820_012_0	1	Generic	4	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								14.00		42.00					9.00		27.00													42.00						0.00				14.00				14.00			0.46	0.30				0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	012	0		29	10	S5820_012_0	1	Preferred Brand	4	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								45.00		135.00					35.00		105.00													135.00						90.00				45.00				45.00			1.50	1.16				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	012	0		29	10	S5820_012_0	1	Non-Preferred Drug	4	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											108.00	50		50				86.00	40		40												50						40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	012	0		29	10	S5820_012_0	1	Specialty Tier	4	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											922.00	33		33				922.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	013	0		29	10	S5820_013_0	1	Preferred Generic	4	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					4.00		12.00													24.00						0.00				8.00				8.00			0.26	0.13				0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	013	0		29	10	S5820_013_0	1	Generic	4	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								16.00		48.00					10.00		30.00													48.00						0.00				16.00				16.00			0.53	0.33				0.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	013	0		29	10	S5820_013_0	1	Preferred Brand	4	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								46.00		138.00					35.00		105.00													138.00						90.00				46.00				46.00			1.53	1.16				1.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	013	0		29	10	S5820_013_0	1	Non-Preferred Drug	4	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											105.00	50		50				84.00	40		40												50						40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	013	0		29	10	S5820_013_0	1	Specialty Tier	4	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											880.00	33		33				880.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	014	0		29	10	S5820_014_0	1	Preferred Generic	4	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								7.00		21.00					3.00		9.00													21.00						0.00				7.00				7.00			0.23	0.10				0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	014	0		29	10	S5820_014_0	1	Generic	4	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								14.00		42.00					8.00		24.00													42.00						0.00				14.00				14.00			0.46	0.26				0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	014	0		29	10	S5820_014_0	1	Preferred Brand	4	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								45.00		135.00					35.00		105.00													135.00						90.00				45.00				45.00			1.50	1.16				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	014	0		29	10	S5820_014_0	1	Non-Preferred Drug	4	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											102.00	50		50				82.00	40		40												50						40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	014	0		29	10	S5820_014_0	1	Specialty Tier	4	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											833.00	33		33				833.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	015	0		29	10	S5820_015_0	2	Preferred Generic	4	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					5.00		15.00													24.00						0.00				8.00				8.00			0.26	0.16				0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	015	0		29	10	S5820_015_0	2	Generic	4	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					10.00		30.00													45.00						0.00				15.00				15.00			0.50	0.33				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	015	0		29	10	S5820_015_0	2	Preferred Brand	4	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					33.00		99.00													141.00						84.00				47.00				47.00			1.56	1.10				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	015	0		29	10	S5820_015_0	2	Non-Preferred Drug	4	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											98.00	44		44				89.00	40		40												44						40			44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	015	0		29	10	S5820_015_0	2	Specialty Tier	4	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											837.00	33		33				837.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	016	0		29	10	S5820_016_0	1	Preferred Generic	4	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								4.00		12.00					2.00		6.00													12.00						0.00				4.00				4.00			0.13	0.06				0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	016	0		29	10	S5820_016_0	1	Generic	4	010000	1	2	2	1		110	01		100	1				30		90	1	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	1	Preferred Brand	4	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					36.00		108.00													141.00						93.00				47.00				47.00			1.56	1.20				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	016	0		29	10	S5820_016_0	1	Non-Preferred Drug	4	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											110.00	50		50				88.00	40		40												50						40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	016	0		29	10	S5820_016_0	1	Specialty Tier	4	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											847.00	33		33				847.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	017	0		29	10	S5820_017_0	1	Preferred Generic	4	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					4.00		12.00													24.00						0.00				8.00				8.00			0.26	0.13				0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	017	0		29	10	S5820_017_0	1	Generic	4	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								16.00		48.00					8.00		24.00													48.00						0.00				16.00				16.00			0.53	0.26				0.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	017	0		29	10	S5820_017_0	1	Preferred Brand	4	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								43.00		129.00					33.00		99.00													129.00						84.00				43.00				43.00			1.43	1.10				1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	017	0		29	10	S5820_017_0	1	Non-Preferred Drug	4	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											106.00	50		50				85.00	40		40												50						40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	017	0		29	10	S5820_017_0	1	Specialty Tier	4	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											838.00	33		33				838.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	018	0		29	10	S5820_018_0	1	Preferred Generic	4	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					3.00		9.00													24.00						0.00				8.00				8.00			0.26	0.10				0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	018	0		29	10	S5820_018_0	1	Generic	4	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								12.00		36.00					8.00		24.00													36.00						0.00				12.00				12.00			0.40	0.26				0.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	018	0		29	10	S5820_018_0	1	Preferred Brand	4	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								45.00		135.00					35.00		105.00													135.00						90.00				45.00				45.00			1.50	1.16				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	018	0		29	10	S5820_018_0	1	Non-Preferred Drug	4	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											90.00	50		50				72.00	40		40												50						40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	018	0		29	10	S5820_018_0	1	Specialty Tier	4	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											936.00	33		33				936.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	019	0		29	10	S5820_019_0	1	Preferred Generic	4	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					3.00		9.00													24.00						0.00				8.00				8.00			0.26	0.10				0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	019	0		29	10	S5820_019_0	1	Generic	4	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								13.00		39.00					7.00		21.00													39.00						0.00				13.00				13.00			0.43	0.23				0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	019	0		29	10	S5820_019_0	1	Preferred Brand	4	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								42.00		126.00					32.00		96.00													126.00						81.00				42.00				42.00			1.40	1.06				1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	019	0		29	10	S5820_019_0	1	Non-Preferred Drug	4	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											91.00	50		50				73.00	40		40												50						40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	019	0		29	10	S5820_019_0	1	Specialty Tier	4	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											932.00	33		33				932.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	020	0		29	10	S5820_020_0	1	Preferred Generic	4	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								7.00		21.00					2.00		6.00													21.00						0.00				7.00				7.00			0.23	0.06				0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	020	0		29	10	S5820_020_0	1	Generic	4	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								11.00		33.00					6.00		18.00													33.00						0.00				11.00				11.00			0.36	0.20				0.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	020	0		29	10	S5820_020_0	1	Preferred Brand	4	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								46.00		138.00					35.00		105.00													138.00						90.00				46.00				46.00			1.53	1.16				1.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	020	0		29	10	S5820_020_0	1	Non-Preferred Drug	4	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											99.00	50		50				79.00	40		40												50						40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	020	0		29	10	S5820_020_0	1	Specialty Tier	4	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											937.00	33		33				937.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	021	0		29	10	S5820_021_0	1	Preferred Generic	4	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								6.00		18.00					3.00		9.00													18.00						0.00				6.00				6.00			0.20	0.10				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	021	0		29	10	S5820_021_0	1	Generic	4	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								17.00		51.00					12.00		36.00													51.00						0.00				17.00				17.00			0.56	0.40				0.54	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	021	0		29	10	S5820_021_0	1	Preferred Brand	4	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								42.00		126.00					32.00		96.00													126.00						81.00				42.00				42.00			1.40	1.06				1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	021	0		29	10	S5820_021_0	1	Non-Preferred Drug	4	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											110.00	50		50				88.00	40		40												50						40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	021	0		29	10	S5820_021_0	1	Specialty Tier	4	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											936.00	33		33				936.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	022	0		29	10	S5820_022_0	1	Preferred Generic	4	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								9.00		27.00					3.00		9.00													27.00						0.00				9.00				9.00			0.30	0.10				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	022	0		29	10	S5820_022_0	1	Generic	4	010000	1	2	2	1		110	01		100	1				30		90	1	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	1	Preferred Brand	4	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								42.00		126.00					32.00		96.00													126.00						81.00				42.00				42.00			1.40	1.06				1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	022	0		29	10	S5820_022_0	1	Non-Preferred Drug	4	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											96.00	50		50				76.00	40		40												50						40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	022	0		29	10	S5820_022_0	1	Specialty Tier	4	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											857.00	33		33				857.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	023	0		29	10	S5820_023_0	1	Preferred Generic	4	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					3.00		9.00													15.00						0.00				5.00				5.00			0.16	0.10				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	023	0		29	10	S5820_023_0	1	Generic	4	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					10.00		30.00													45.00						0.00				15.00				15.00			0.50	0.33				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	023	0		29	10	S5820_023_0	1	Preferred Brand	4	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								45.00		135.00					35.00		105.00													135.00						90.00				45.00				45.00			1.50	1.16				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	023	0		29	10	S5820_023_0	1	Non-Preferred Drug	4	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											105.00	50		50				84.00	40		40												50						40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	023	0		29	10	S5820_023_0	1	Specialty Tier	4	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											805.00	33		33				805.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	024	0		29	10	S5820_024_0	1	Preferred Generic	4	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								6.00		18.00					3.00		9.00													18.00						0.00				6.00				6.00			0.20	0.10				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	024	0		29	10	S5820_024_0	1	Generic	4	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					10.00		30.00													45.00						0.00				15.00				15.00			0.50	0.33				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	024	0		29	10	S5820_024_0	1	Preferred Brand	4	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								38.00		114.00					35.00		105.00													114.00						90.00				38.00				38.00			1.26	1.16				1.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	024	0		29	10	S5820_024_0	1	Non-Preferred Drug	4	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											110.00	50		50				88.00	40		40												50						40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	024	0		29	10	S5820_024_0	1	Specialty Tier	4	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											769.00	33		33				769.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	025	0		29	10	S5820_025_0	1	Preferred Generic	4	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					5.00		15.00													24.00						0.00				8.00				8.00			0.26	0.16				0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	025	0		29	10	S5820_025_0	1	Generic	4	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					10.00		30.00													45.00						0.00				15.00				15.00			0.50	0.33				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	025	0		29	10	S5820_025_0	1	Preferred Brand	4	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								45.00		135.00					35.00		105.00													135.00						90.00				45.00				45.00			1.50	1.16				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	025	0		29	10	S5820_025_0	1	Non-Preferred Drug	4	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											99.00	50		50				79.00	40		40												50						40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	025	0		29	10	S5820_025_0	1	Specialty Tier	4	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											887.00	33		33				887.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	026	0		29	10	S5820_026_0	2	Preferred Generic	4	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					5.00		15.00													30.00						0.00				10.00				10.00			0.33	0.16				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	026	0		29	10	S5820_026_0	2	Generic	4	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								18.00		54.00					13.00		39.00													54.00						0.00				18.00				18.00			0.60	0.43				0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	026	0		29	10	S5820_026_0	2	Preferred Brand	4	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					35.00		105.00													141.00						90.00				47.00				47.00			1.56	1.16				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	026	0		29	10	S5820_026_0	2	Non-Preferred Drug	4	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											100.00	44		44				90.00	40		40												44						40			44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	026	0		29	10	S5820_026_0	2	Specialty Tier	4	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											840.00	33		33				840.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	027	0		29	10	S5820_027_0	1	Preferred Generic	4	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					5.00		15.00													30.00						0.00				10.00				10.00			0.33	0.16				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	027	0		29	10	S5820_027_0	1	Generic	4	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								18.00		54.00					13.00		39.00													54.00						0.00				18.00				18.00			0.60	0.43				0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	027	0		29	10	S5820_027_0	1	Preferred Brand	4	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								39.00		117.00					35.00		105.00													117.00						90.00				39.00				39.00			1.30	1.16				1.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	027	0		29	10	S5820_027_0	1	Non-Preferred Drug	4	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											107.00	50		50				85.00	40		40												50						40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	027	0		29	10	S5820_027_0	1	Specialty Tier	4	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											1040.00	33		33				1040.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	028	0		29	10	S5820_028_0	1	Preferred Generic	4	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					5.00		15.00													24.00						0.00				8.00				8.00			0.26	0.16				0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	028	0		29	10	S5820_028_0	1	Generic	4	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					10.00		30.00													45.00						0.00				15.00				15.00			0.50	0.33				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	028	0		29	10	S5820_028_0	1	Preferred Brand	4	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								45.00		135.00					35.00		105.00													135.00						90.00				45.00				45.00			1.50	1.16				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	028	0		29	10	S5820_028_0	1	Non-Preferred Drug	4	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											105.00	50		50				84.00	40		40												50						40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	028	0		29	10	S5820_028_0	1	Specialty Tier	4	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											1123.00	33		33				1123.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	029	0		29	10	S5820_029_0	1	Preferred Generic	4	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								7.00		21.00					4.00		12.00													21.00						0.00				7.00				7.00			0.23	0.13				0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	029	0		29	10	S5820_029_0	1	Generic	4	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					10.00		30.00													45.00						0.00				15.00				15.00			0.50	0.33				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	029	0		29	10	S5820_029_0	1	Preferred Brand	4	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								45.00		135.00					35.00		105.00													135.00						90.00				45.00				45.00			1.50	1.16				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	029	0		29	10	S5820_029_0	1	Non-Preferred Drug	4	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											103.00	50		50				82.00	40		40												50						40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	029	0		29	10	S5820_029_0	1	Specialty Tier	4	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											870.00	33		33				870.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	030	0		29	10	S5820_030_0	1	Preferred Generic	4	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								6.00		18.00					3.00		9.00													18.00						0.00				6.00				6.00			0.20	0.10				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	030	0		29	10	S5820_030_0	1	Generic	4	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								13.00		39.00					8.00		24.00													39.00						0.00				13.00				13.00			0.43	0.26				0.41	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	030	0		29	10	S5820_030_0	1	Preferred Brand	4	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								45.00		135.00					35.00		105.00													135.00						90.00				45.00				45.00			1.50	1.16				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	030	0		29	10	S5820_030_0	1	Non-Preferred Drug	4	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											99.00	50		50				79.00	40		40												50						40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	030	0		29	10	S5820_030_0	1	Specialty Tier	4	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											993.00	33		33				993.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	031	0		29	10	S5820_031_0	1	Preferred Generic	4	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					4.00		12.00													24.00						0.00				8.00				8.00			0.26	0.13				0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	031	0		29	10	S5820_031_0	1	Generic	4	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					10.00		30.00													45.00						0.00				15.00				15.00			0.50	0.33				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	031	0		29	10	S5820_031_0	1	Preferred Brand	4	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								38.00		114.00					35.00		105.00													114.00						90.00				38.00				38.00			1.26	1.16				1.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	031	0		29	10	S5820_031_0	1	Non-Preferred Drug	4	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											105.00	43		43				91.00	37		37												43						37			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	031	0		29	10	S5820_031_0	1	Specialty Tier	4	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											1031.00	33		33				1031.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	032	0		29	10	S5820_032_0	1	Preferred Generic	4	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					5.00		15.00													24.00						0.00				8.00				8.00			0.26	0.16				0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	032	0		29	10	S5820_032_0	1	Generic	4	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					10.00		30.00													45.00						0.00				15.00				15.00			0.50	0.33				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	032	0		29	10	S5820_032_0	1	Preferred Brand	4	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								45.00		135.00					35.00		105.00													135.00						90.00				45.00				45.00			1.50	1.16				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	032	0		29	10	S5820_032_0	1	Non-Preferred Drug	4	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											104.00	44		44				90.00	38		38												44						38			44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	032	0		29	10	S5820_032_0	1	Specialty Tier	4	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											1006.00	33		33				1006.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	033	0		29	10	S5820_033_0	1	Preferred Generic	4	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					5.00		15.00													24.00						0.00				8.00				8.00			0.26	0.16				0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	033	0		29	10	S5820_033_0	1	Generic	4	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					10.00		30.00													45.00						0.00				15.00				15.00			0.50	0.33				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	033	0		29	10	S5820_033_0	1	Preferred Brand	4	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								45.00		135.00					35.00		105.00													135.00						90.00				45.00				45.00			1.50	1.16				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	033	0		29	10	S5820_033_0	1	Non-Preferred Drug	4	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											107.00	50		50				86.00	40		40												50						40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	033	0		29	10	S5820_033_0	1	Specialty Tier	4	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											722.00	33		33				722.00	33		33												33						33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	034	0		29	10	S5820_034_0	1	Preferred Generic	2	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	2.00		6.00																					6.00																2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	034	0		29	10	S5820_034_0	1	Generic	2	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	5.00		15.00																					15.00																5.00				5.00		0.16						0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	034	0		29	10	S5820_034_0	1	Preferred Brand	2	010001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	36.00		108.00																					108.00																36.00				36.00		1.20						1.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	034	0		29	10	S5820_034_0	1	Non-Preferred Drug	2	100100	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				99.00	42		42																				42															42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	034	0		29	10	S5820_034_0	1	Specialty Tier	2	010010	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31				638.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	035	0		29	10	S5820_035_0	1	Preferred Generic	2	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	2.00		6.00																					6.00																2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	035	0		29	10	S5820_035_0	1	Generic	2	010000	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 Drug, Specialty Tier												
S5820	035	0		29	10	S5820_035_0	1	Preferred Brand	2	010001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	36.00		108.00																					108.00																36.00				36.00		1.20						1.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	035	0		29	10	S5820_035_0	1	Non-Preferred Drug	2	100100	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				86.00	39		39																				39															39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	035	0		29	10	S5820_035_0	1	Specialty Tier	2	010010	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31				730.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	036	0		29	10	S5820_036_0	1	Preferred Generic	2	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	2.00		6.00																					6.00																2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	036	0		29	10	S5820_036_0	1	Generic	2	010000	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		0.26						0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	036	0		29	10	S5820_036_0	1	Preferred Brand	2	010001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	27.00		81.00																					81.00																27.00				27.00		0.90						0.87	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	036	0		29	10	S5820_036_0	1	Non-Preferred Drug	2	100100	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				83.00	43		43																				43															43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	036	0		29	10	S5820_036_0	1	Specialty Tier	2	010010	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31				621.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	037	0		29	10	S5820_037_0	1	Preferred Generic	2	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								2.00		6.00					1.00		3.00													6.00						3.00				2.00				2.00			0.06	0.03				0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	037	0		29	10	S5820_037_0	1	Generic	2	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								6.00		18.00					2.00		6.00													18.00						6.00				6.00				6.00			0.20	0.06				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	037	0		29	10	S5820_037_0	1	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								30.00		90.00					20.00		60.00													90.00						60.00				30.00				30.00			1.00	0.66				0.96	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	037	0		29	10	S5820_037_0	1	Non-Preferred Drug	2	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											109.00	45		45				94.00	39		39												45						39			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	037	0		29	10	S5820_037_0	1	Specialty Tier	2	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											987.00	25		25				987.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	038	0		29	10	S5820_038_0	1	Preferred Generic	2	001000	1	2	1	1	110		01	100		1	30		90				1	2			90				30		31	2.00		6.00																					6.00																2.00				2.00		0.06						0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	038	0		29	10	S5820_038_0	1	Generic	2	010000	1	2	2	1	110		01	100		1	30		90				1	2			90				30		31	7.00		21.00																					21.00																7.00				7.00		0.23						0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	038	0		29	10	S5820_038_0	1	Preferred Brand	2	010001	1	2	3	1	110		01	100		1	30		90				1	2			90				30		31	29.00		87.00																					87.00																29.00				29.00		0.96						0.93	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	038	0		29	10	S5820_038_0	1	Non-Preferred Drug	2	100100	1	1	4	1	110		01	100		1	30		90				1	2			90				30		31				99.00	44		44																				44															44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5820	038	0		29	10	S5820_038_0	1	Specialty Tier	2	010010	1	1	5	1	110		01	100		1	30		90				1	2			90				30		31				656.00	25		25																				25															25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5877	004	0		29	10	S5877_004_0	3	Preferred Generic	2	001000	1	2	1	1	110		10	100		1	34		90				1	2			90					29	34	8.00		24.00																					24.00																	8.00			8.00		0.24						0.24	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5877	004	0		29	10	S5877_004_0	3	Preferred Brand	2	000001	1	2	2	1	110		10	100		1	34		90				1	2			90					29	34	47.00		141.00																					141.00																	47.00			47.00		1.38						1.38	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5877	004	0		29	10	S5877_004_0	3	Non-Preferred Drug	2	100000	1	2	3	1	110		10	100		1	34		90				1	2			90					29	34	100.00		300.00																					300.00																	100.00			100.00		2.94						2.94	Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5877	004	0		29	10	S5877_004_0	3	Specialty Tier	2	010010	1	1	4	1	110		10	100		1	34		90				1	2			90					29	34				1.00	25		25																				25																25		25								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5877	007	0		29	10	S5877_007_0	5	Preferred Generic	4	001000	1	1	1	1	110		10	100		1	34		90				1	2			90					29	34				2.00	10		10																				10																10		10								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5877	007	0		29	10	S5877_007_0	5	Preferred Brand	4	000001	1	1	2	1	110		10	100		1	34		90				1	2			90					29	34				41.00	20		20																				20																20		20								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5877	007	0		29	10	S5877_007_0	5	Non-Preferred Drug	4	100000	1	1	3	1	110		10	100		1	34		90				1	2			90					29	34				59.00	40		40																				40																40		40								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5877	007	0		29	10	S5877_007_0	5	Specialty Tier	4	010010	1	1	4	1	110		10	100		1	34		90				1	2			90					29	34				1.00	33		33																				33																33		33								Preferred Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	001	0		29	10	S5884_001_0	2	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	001	0		29	10	S5884_001_0	2	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	001	0		29	10	S5884_001_0	2	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	001	0		29	10	S5884_001_0	2	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5884	001	0		29	10	S5884_001_0	2	Non-Preferred Drug	4	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											68.00	50		50				56.00	44		44										50		50				44		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	001	0		29	10	S5884_001_0	2	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.17	3.13		3.17	3.13	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5884	001	0		29	10	S5884_001_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	002	0		29	10	S5884_002_0	2	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	002	0		29	10	S5884_002_0	2	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	002	0		29	10	S5884_002_0	2	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	002	0		29	10	S5884_002_0	2	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5884	002	0		29	10	S5884_002_0	2	Non-Preferred Drug	4	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											80.00	50		50				66.00	44		44										50		50				44		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	002	0		29	10	S5884_002_0	2	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.17	3.13		3.17	3.13	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5884	002	0		29	10	S5884_002_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	004	0		29	10	S5884_004_0	2	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	004	0		29	10	S5884_004_0	2	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	004	0		29	10	S5884_004_0	2	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	004	0		29	10	S5884_004_0	2	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5884	004	0		29	10	S5884_004_0	2	Non-Preferred Drug	4	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											76.00	50		50				63.00	44		44										50		50				44		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	004	0		29	10	S5884_004_0	2	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.17	3.13		3.17	3.13	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5884	004	0		29	10	S5884_004_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	005	0		29	10	S5884_005_0	2	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	005	0		29	10	S5884_005_0	2	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	005	0		29	10	S5884_005_0	2	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	005	0		29	10	S5884_005_0	2	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5884	005	0		29	10	S5884_005_0	2	Non-Preferred Drug	4	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											74.00	50		50				61.00	44		44										50		50				44		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	005	0		29	10	S5884_005_0	2	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.17	3.13		3.17	3.13	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5884	005	0		29	10	S5884_005_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	008	0		29	10	S5884_008_0	2	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	008	0		29	10	S5884_008_0	2	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	008	0		29	10	S5884_008_0	2	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	008	0		29	10	S5884_008_0	2	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5884	008	0		29	10	S5884_008_0	2	Non-Preferred Drug	4	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											68.00	50		50				57.00	44		44										50		50				44		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	008	0		29	10	S5884_008_0	2	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.17	3.13		3.17	3.13	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5884	008	0		29	10	S5884_008_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	009	0		29	10	S5884_009_0	2	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	009	0		29	10	S5884_009_0	2	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	009	0		29	10	S5884_009_0	2	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	009	0		29	10	S5884_009_0	2	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5884	009	0		29	10	S5884_009_0	2	Non-Preferred Drug	4	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											69.00	50		50				58.00	44		44										50		50				44		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	009	0		29	10	S5884_009_0	2	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.17	3.13		3.17	3.13	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5884	009	0		29	10	S5884_009_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	010	0		29	10	S5884_010_0	2	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	010	0		29	10	S5884_010_0	2	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		7.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	010	0		29	10	S5884_010_0	2	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	010	0		29	10	S5884_010_0	2	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5884	010	0		29	10	S5884_010_0	2	Non-Preferred Drug	4	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											81.00	50		50				66.00	44		44										50		50				44		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	010	0		29	10	S5884_010_0	2	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.17	3.13		3.17	3.13	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5884	010	0		29	10	S5884_010_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	015	0		29	10	S5884_015_0	2	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	015	0		29	10	S5884_015_0	2	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	015	0		29	10	S5884_015_0	2	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	015	0		29	10	S5884_015_0	2	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5884	015	0		29	10	S5884_015_0	2	Non-Preferred Drug	4	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											75.00	50		50				62.00	44		44										50		50				44		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	015	0		29	10	S5884_015_0	2	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.17	3.13		3.17	3.13	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5884	015	0		29	10	S5884_015_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	019	0		29	10	S5884_019_0	2	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	019	0		29	10	S5884_019_0	2	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	019	0		29	10	S5884_019_0	2	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	019	0		29	10	S5884_019_0	2	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5884	019	0		29	10	S5884_019_0	2	Non-Preferred Drug	4	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											72.00	50		50				60.00	44		44										50		50				44		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	019	0		29	10	S5884_019_0	2	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.17	3.13		3.17	3.13	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5884	019	0		29	10	S5884_019_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	020	0		29	10	S5884_020_0	2	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	020	0		29	10	S5884_020_0	2	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	020	0		29	10	S5884_020_0	2	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	020	0		29	10	S5884_020_0	2	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5884	020	0		29	10	S5884_020_0	2	Non-Preferred Drug	4	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											74.00	50		50				61.00	44		44										50		50				44		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	020	0		29	10	S5884_020_0	2	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.17	3.13		3.17	3.13	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5884	020	0		29	10	S5884_020_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	021	0		29	10	S5884_021_0	2	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	021	0		29	10	S5884_021_0	2	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	021	0		29	10	S5884_021_0	2	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	021	0		29	10	S5884_021_0	2	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5884	021	0		29	10	S5884_021_0	2	Non-Preferred Drug	4	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											70.00	50		50				58.00	44		44										50		50				44		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	021	0		29	10	S5884_021_0	2	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.17	3.13		3.17	3.13	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5884	021	0		29	10	S5884_021_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	022	0		29	10	S5884_022_0	2	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	022	0		29	10	S5884_022_0	2	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	022	0		29	10	S5884_022_0	2	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	022	0		29	10	S5884_022_0	2	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5884	022	0		29	10	S5884_022_0	2	Non-Preferred Drug	4	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											72.00	50		50				58.00	44		44										50		50				44		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	022	0		29	10	S5884_022_0	2	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.17	3.13		3.17	3.13	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5884	022	0		29	10	S5884_022_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	024	0		29	10	S5884_024_0	2	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	024	0		29	10	S5884_024_0	2	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	024	0		29	10	S5884_024_0	2	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	024	0		29	10	S5884_024_0	2	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5884	024	0		29	10	S5884_024_0	2	Non-Preferred Drug	4	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											64.00	50		50				53.00	44		44										50		50				44		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	024	0		29	10	S5884_024_0	2	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.17	3.13		3.17	3.13	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5884	024	0		29	10	S5884_024_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	028	0		29	10	S5884_028_0	2	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	028	0		29	10	S5884_028_0	2	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	028	0		29	10	S5884_028_0	2	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	028	0		29	10	S5884_028_0	2	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5884	028	0		29	10	S5884_028_0	2	Non-Preferred Drug	4	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											65.00	50		50				54.00	44		44										50		50				44		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	028	0		29	10	S5884_028_0	2	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.17	3.13		3.17	3.13	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5884	028	0		29	10	S5884_028_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	030	0		29	10	S5884_030_0	2	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	030	0		29	10	S5884_030_0	2	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	030	0		29	10	S5884_030_0	2	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	030	0		29	10	S5884_030_0	2	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5884	030	0		29	10	S5884_030_0	2	Non-Preferred Drug	4	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											78.00	50		50				65.00	44		44										50		50				44		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	030	0		29	10	S5884_030_0	2	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.17	3.13		3.17	3.13	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5884	030	0		29	10	S5884_030_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	062	0		29	10	S5884_062_0	2	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	062	0		29	10	S5884_062_0	2	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	062	0		29	10	S5884_062_0	2	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	062	0		29	10	S5884_062_0	2	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5884	062	0		29	10	S5884_062_0	2	Non-Preferred Drug	4	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											76.00	50		50				63.00	44		44										50		50				44		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	062	0		29	10	S5884_062_0	2	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.17	3.13		3.17	3.13	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5884	062	0		29	10	S5884_062_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	065	0		29	10	S5884_065_0	2	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	065	0		29	10	S5884_065_0	2	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	065	0		29	10	S5884_065_0	2	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	065	0		29	10	S5884_065_0	2	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5884	065	0		29	10	S5884_065_0	2	Non-Preferred Drug	4	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											71.00	50		50				59.00	44		44										50		50				44		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	065	0		29	10	S5884_065_0	2	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.17	3.13		3.17	3.13	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5884	065	0		29	10	S5884_065_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	066	0		29	10	S5884_066_0	2	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	066	0		29	10	S5884_066_0	2	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	066	0		29	10	S5884_066_0	2	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	066	0		29	10	S5884_066_0	2	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5884	066	0		29	10	S5884_066_0	2	Non-Preferred Drug	4	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											72.00	50		50				59.00	44		44										50		50				44		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	066	0		29	10	S5884_066_0	2	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.17	3.13		3.17	3.13	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5884	066	0		29	10	S5884_066_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	071	0		29	10	S5884_071_0	2	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	071	0		29	10	S5884_071_0	2	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	071	0		29	10	S5884_071_0	2	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	071	0		29	10	S5884_071_0	2	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5884	071	0		29	10	S5884_071_0	2	Non-Preferred Drug	4	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											72.00	50		50				59.00	44		44										50		50				44		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	071	0		29	10	S5884_071_0	2	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.17	3.13		3.17	3.13	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5884	071	0		29	10	S5884_071_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	072	0		29	10	S5884_072_0	2	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	072	0		29	10	S5884_072_0	2	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	072	0		29	10	S5884_072_0	2	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	072	0		29	10	S5884_072_0	2	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5884	072	0		29	10	S5884_072_0	2	Non-Preferred Drug	4	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											73.00	50		50				60.00	44		44										50		50				44		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	072	0		29	10	S5884_072_0	2	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.17	3.13		3.17	3.13	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5884	072	0		29	10	S5884_072_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	073	0		29	10	S5884_073_0	2	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	073	0		29	10	S5884_073_0	2	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	073	0		29	10	S5884_073_0	2	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	073	0		29	10	S5884_073_0	2	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5884	073	0		29	10	S5884_073_0	2	Non-Preferred Drug	4	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											75.00	50		50				61.00	44		44										50		50				44		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	073	0		29	10	S5884_073_0	2	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.17	3.13		3.17	3.13	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5884	073	0		29	10	S5884_073_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	074	0		29	10	S5884_074_0	2	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	074	0		29	10	S5884_074_0	2	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	074	0		29	10	S5884_074_0	2	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	074	0		29	10	S5884_074_0	2	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5884	074	0		29	10	S5884_074_0	2	Non-Preferred Drug	4	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											71.00	50		50				58.00	44		44										50		50				44		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	074	0		29	10	S5884_074_0	2	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.17	3.13		3.17	3.13	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5884	074	0		29	10	S5884_074_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	076	0		29	10	S5884_076_0	2	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	076	0		29	10	S5884_076_0	2	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	076	0		29	10	S5884_076_0	2	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	076	0		29	10	S5884_076_0	2	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5884	076	0		29	10	S5884_076_0	2	Non-Preferred Drug	4	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											71.00	50		50				58.00	44		44										50		50				44		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	076	0		29	10	S5884_076_0	2	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.17	3.13		3.17	3.13	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5884	076	0		29	10	S5884_076_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	077	0		29	10	S5884_077_0	2	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	077	0		29	10	S5884_077_0	2	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	077	0		29	10	S5884_077_0	2	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	077	0		29	10	S5884_077_0	2	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5884	077	0		29	10	S5884_077_0	2	Non-Preferred Drug	4	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											65.00	50		50				53.00	44		44										50		50				44		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	077	0		29	10	S5884_077_0	2	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.17	3.13		3.17	3.13	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5884	077	0		29	10	S5884_077_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	078	0		29	10	S5884_078_0	2	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	078	0		29	10	S5884_078_0	2	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	078	0		29	10	S5884_078_0	2	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	078	0		29	10	S5884_078_0	2	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5884	078	0		29	10	S5884_078_0	2	Non-Preferred Drug	4	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											68.00	50		50				56.00	44		44										50		50				44		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	078	0		29	10	S5884_078_0	2	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.17	3.13		3.17	3.13	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5884	078	0		29	10	S5884_078_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	083	0		29	10	S5884_083_0	2	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	083	0		29	10	S5884_083_0	2	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	083	0		29	10	S5884_083_0	2	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	083	0		29	10	S5884_083_0	2	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5884	083	0		29	10	S5884_083_0	2	Non-Preferred Drug	4	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											68.00	50		50				56.00	44		44										50		50				44		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	083	0		29	10	S5884_083_0	2	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.17	3.13		3.17	3.13	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5884	083	0		29	10	S5884_083_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	085	0		29	10	S5884_085_0	2	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	085	0		29	10	S5884_085_0	2	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	085	0		29	10	S5884_085_0	2	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	085	0		29	10	S5884_085_0	2	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5884	085	0		29	10	S5884_085_0	2	Non-Preferred Drug	4	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											72.00	50		50				61.00	44		44										50		50				44		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	085	0		29	10	S5884_085_0	2	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.17	3.13		3.17	3.13	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5884	085	0		29	10	S5884_085_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	086	0		29	10	S5884_086_0	2	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	086	0		29	10	S5884_086_0	2	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		7.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	086	0		29	10	S5884_086_0	2	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	086	0		29	10	S5884_086_0	2	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5884	086	0		29	10	S5884_086_0	2	Non-Preferred Drug	4	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											69.00	50		50				57.00	44		44										50		50				44		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	086	0		29	10	S5884_086_0	2	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.17	3.13		3.17	3.13	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5884	086	0		29	10	S5884_086_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	087	0		29	10	S5884_087_0	2	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	087	0		29	10	S5884_087_0	2	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	087	0		29	10	S5884_087_0	2	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	087	0		29	10	S5884_087_0	2	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5884	087	0		29	10	S5884_087_0	2	Non-Preferred Drug	4	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											82.00	50		50				69.00	44		44										50		50				44		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	087	0		29	10	S5884_087_0	2	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.17	3.13		3.17	3.13	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5884	087	0		29	10	S5884_087_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	089	0		29	10	S5884_089_0	2	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	089	0		29	10	S5884_089_0	2	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	089	0		29	10	S5884_089_0	2	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	089	0		29	10	S5884_089_0	2	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5884	089	0		29	10	S5884_089_0	2	Non-Preferred Drug	4	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											64.00	50		50				52.00	44		44										50		50				44		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	089	0		29	10	S5884_089_0	2	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.17	3.13		3.17	3.13	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5884	089	0		29	10	S5884_089_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	092	0		29	10	S5884_092_0	2	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	092	0		29	10	S5884_092_0	2	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	092	0		29	10	S5884_092_0	2	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	092	0		29	10	S5884_092_0	2	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5884	092	0		29	10	S5884_092_0	2	Non-Preferred Drug	4	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											84.00	50		50				69.00	44		44										50		50				44		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	092	0		29	10	S5884_092_0	2	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.17	3.13		3.17	3.13	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5884	092	0		29	10	S5884_092_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	093	0		29	10	S5884_093_0	2	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	093	0		29	10	S5884_093_0	2	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	093	0		29	10	S5884_093_0	2	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	093	0		29	10	S5884_093_0	2	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5884	093	0		29	10	S5884_093_0	2	Non-Preferred Drug	4	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											73.00	50		50				60.00	44		44										50		50				44		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	093	0		29	10	S5884_093_0	2	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.17	3.13		3.17	3.13	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5884	093	0		29	10	S5884_093_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	094	0		29	10	S5884_094_0	2	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								7.00		21.00					3.00		9.00											7.00		21.00				3.00		0.00				7.00				7.00			0.23	0.10		0.23	0.10	0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	094	0		29	10	S5884_094_0	2	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								12.00		36.00					7.00		21.00											12.00		36.00				7.00		0.00				12.00				12.00			0.40	0.23		0.40	0.23	0.39	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	094	0		29	10	S5884_094_0	2	Preferred Brand	4	010001	1	2	3	1		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	094	0		29	10	S5884_094_0	2	Preferred Brand	4	010001	1	2	3	3		110	01		110	1				30		90	2	2				30		90	30		31								47.00		141.00					42.00		126.00											47.00		141.00				42.00		116.00				47.00				47.00			1.57	1.40		1.57	1.40	1.52	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5884	094	0		29	10	S5884_094_0	2	Non-Preferred Drug	4	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											77.00	50		50				58.00	44		44										50		50				44		44			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	094	0		29	10	S5884_094_0	2	Non-Preferred Drug	4	110000	1	2	4	3		110	01		110	1				30		90	2	2				30		90	30		31								95.00		285.00					94.00		282.00											95.00		285.00				94.00		272.00				95.00				95.00			3.17	3.13		3.17	3.13	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										2	1	
S5884	094	0		29	10	S5884_094_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												33							33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	101	0		29	10	S5884_101_0	4	Preferred Generic	2	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0		0.07	0	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	101	0		29	10	S5884_101_0	4	Generic	2	010001	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												
S5884	101	0		29	10	S5884_101_0	4	Preferred Brand	2	010001	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											26.00	25		25				20.00	20		20										25		25				20		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	101	0		29	10	S5884_101_0	4	Non-Preferred Drug	2	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											68.00	43		43				52.00	35		35										43		43				35		30			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	101	0		29	10	S5884_101_0	4	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	102	0		29	10	S5884_102_0	2	Preferred Generic	2	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0		0.07	0	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	102	0		29	10	S5884_102_0	2	Generic	2	010001	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												
S5884	102	0		29	10	S5884_102_0	2	Preferred Brand	2	010001	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											27.00	25		25				21.00	20		20										25		25				20		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	102	0		29	10	S5884_102_0	2	Non-Preferred Drug	2	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											64.00	38		38				56.00	35		35										38		38				35		30			38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	102	0		29	10	S5884_102_0	2	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	103	0		29	10	S5884_103_0	2	Preferred Generic	2	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0		0.07	0	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	103	0		29	10	S5884_103_0	2	Generic	2	010001	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												
S5884	103	0		29	10	S5884_103_0	2	Preferred Brand	2	010001	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											28.00	25		25				21.00	20		20										25		25				20		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	103	0		29	10	S5884_103_0	2	Non-Preferred Drug	2	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											72.00	40		40				60.00	35		35										40		40				35		30			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	103	0		29	10	S5884_103_0	2	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	104	0		29	10	S5884_104_0	2	Preferred Generic	2	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0		0.07	0	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	104	0		29	10	S5884_104_0	2	Generic	2	010001	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												
S5884	104	0		29	10	S5884_104_0	2	Preferred Brand	2	010001	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											27.00	25		25				20.00	20		20										25		25				20		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	104	0		29	10	S5884_104_0	2	Non-Preferred Drug	2	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											71.00	41		41				57.00	35		35										41		41				35		30			41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	104	0		29	10	S5884_104_0	2	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	105	0		29	10	S5884_105_0	2	Preferred Generic	2	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0		0.07	0	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	105	0		29	10	S5884_105_0	2	Generic	2	010001	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												
S5884	105	0		29	10	S5884_105_0	2	Preferred Brand	2	010001	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											26.00	25		25				19.00	20		20										25		25				20		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	105	0		29	10	S5884_105_0	2	Non-Preferred Drug	2	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											84.00	46		46				57.00	35		35										46		46				35		30			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	105	0		29	10	S5884_105_0	2	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	106	0		29	10	S5884_106_0	2	Preferred Generic	2	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0		0.07	0	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	106	0		29	10	S5884_106_0	2	Generic	2	010001	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												
S5884	106	0		29	10	S5884_106_0	2	Preferred Brand	2	010001	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											26.00	25		25				19.00	20		20										25		25				20		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	106	0		29	10	S5884_106_0	2	Non-Preferred Drug	2	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											74.00	41		41				58.00	35		35										41		41				35		30			41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	106	0		29	10	S5884_106_0	2	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	107	0		29	10	S5884_107_0	2	Preferred Generic	2	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0		0.07	0	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	107	0		29	10	S5884_107_0	2	Generic	2	010001	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												
S5884	107	0		29	10	S5884_107_0	2	Preferred Brand	2	010001	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											29.00	25		25				22.00	20		20										25		25				20		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	107	0		29	10	S5884_107_0	2	Non-Preferred Drug	2	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											85.00	47		47				58.00	35		35										47		47				35		30			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	107	0		29	10	S5884_107_0	2	Specialty Tier	2	010010	1	1	5	1		010	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	2	Preferred Generic	2	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0		0.07	0	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	108	0		29	10	S5884_108_0	2	Generic	2	010001	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												
S5884	108	0		29	10	S5884_108_0	2	Preferred Brand	2	010001	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											27.00	25		25				20.00	20		20										25		25				20		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	108	0		29	10	S5884_108_0	2	Non-Preferred Drug	2	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											74.00	42		42				57.00	35		35										42		42				35		30			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	108	0		29	10	S5884_108_0	2	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	109	0		29	10	S5884_109_0	2	Preferred Generic	2	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0		0.07	0	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	109	0		29	10	S5884_109_0	2	Generic	2	010001	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												
S5884	109	0		29	10	S5884_109_0	2	Preferred Brand	2	010001	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											27.00	25		25				20.00	20		20										25		25				20		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	109	0		29	10	S5884_109_0	2	Non-Preferred Drug	2	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											67.00	37		37				57.00	35		35										37		37				35		30			37			37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	109	0		29	10	S5884_109_0	2	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	110	0		29	10	S5884_110_0	2	Preferred Generic	2	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								4.00		12.00					0.00		0.00											4.00		12.00				0.00		0.00				4.00				4.00			0.13	0		0.13	0	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	110	0		29	10	S5884_110_0	2	Generic	2	010001	1	2	2	1		110	01		110	1				30		90	2	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	110	0		29	10	S5884_110_0	2	Preferred Brand	2	010001	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											29.00	25		25				22.00	20		20										25		25				20		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	110	0		29	10	S5884_110_0	2	Non-Preferred Drug	2	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											72.00	47		47				51.00	35		35										47		47				35		30			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	110	0		29	10	S5884_110_0	2	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	111	0		29	10	S5884_111_0	2	Preferred Generic	2	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0		0.07	0	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	111	0		29	10	S5884_111_0	2	Generic	2	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								4.00		12.00					1.00		3.00											4.00		12.00				1.00		0.00				4.00				4.00			0.13	0.03		0.13	0.03	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	111	0		29	10	S5884_111_0	2	Preferred Brand	2	010001	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											26.00	25		25				20.00	20		20										25		25				20		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	111	0		29	10	S5884_111_0	2	Non-Preferred Drug	2	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											78.00	44		44				57.00	35		35										44		44				35		30			44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	111	0		29	10	S5884_111_0	2	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	112	0		29	10	S5884_112_0	2	Preferred Generic	2	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								4.00		12.00					0.00		0.00											4.00		12.00				0.00		0.00				4.00				4.00			0.13	0		0.13	0	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	112	0		29	10	S5884_112_0	2	Generic	2	010001	1	2	2	1		110	01		110	1				30		90	2	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	112	0		29	10	S5884_112_0	2	Preferred Brand	2	010001	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											26.00	25		25				19.00	20		20										25		25				20		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	112	0		29	10	S5884_112_0	2	Non-Preferred Drug	2	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											88.00	50		50				55.00	35		35										50		50				35		30			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	112	0		29	10	S5884_112_0	2	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	113	0		29	10	S5884_113_0	2	Preferred Generic	2	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0		0.07	0	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	113	0		29	10	S5884_113_0	2	Generic	2	010001	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												
S5884	113	0		29	10	S5884_113_0	2	Preferred Brand	2	010001	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											25.00	25		25				19.00	20		20										25		25				20		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	113	0		29	10	S5884_113_0	2	Non-Preferred Drug	2	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											68.00	42		42				53.00	35		35										42		42				35		30			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	113	0		29	10	S5884_113_0	2	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	114	0		29	10	S5884_114_0	2	Preferred Generic	2	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0		0.07	0	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	114	0		29	10	S5884_114_0	2	Generic	2	010001	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												
S5884	114	0		29	10	S5884_114_0	2	Preferred Brand	2	010001	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											30.00	24		24				24.00	20		20										24		24				20		15			24			24								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	114	0		29	10	S5884_114_0	2	Non-Preferred Drug	2	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											71.00	37		37				65.00	35		35										37		37				35		30			37			37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	114	0		29	10	S5884_114_0	2	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	115	0		29	10	S5884_115_0	2	Preferred Generic	2	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								3.00		9.00					0.00		0.00											3.00		9.00				0.00		0.00				3.00				3.00			0.10	0		0.10	0	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	115	0		29	10	S5884_115_0	2	Generic	2	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								4.00		12.00					1.00		3.00											4.00		12.00				1.00		0.00				4.00				4.00			0.13	0.03		0.13	0.03	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	115	0		29	10	S5884_115_0	2	Preferred Brand	2	010001	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											28.00	25		25				20.00	20		20										25		25				20		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	115	0		29	10	S5884_115_0	2	Non-Preferred Drug	2	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											99.00	43		43				78.00	35		35										43		43				35		30			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	115	0		29	10	S5884_115_0	2	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	116	0		29	10	S5884_116_0	2	Preferred Generic	2	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0		0.07	0	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	116	0		29	10	S5884_116_0	2	Generic	2	010001	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												
S5884	116	0		29	10	S5884_116_0	2	Preferred Brand	2	010001	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											25.00	24		24				21.00	20		20										24		24				20		15			24			24								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	116	0		29	10	S5884_116_0	2	Non-Preferred Drug	2	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											58.00	36		36				53.00	35		35										36		36				35		30			36			36								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	116	0		29	10	S5884_116_0	2	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	131	0		29	10	S5884_131_0	2	Preferred Generic	2	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0		0.07	0	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	131	0		29	10	S5884_131_0	2	Generic	2	010001	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												
S5884	131	0		29	10	S5884_131_0	2	Preferred Brand	2	010001	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											27.00	23		23				22.00	20		20										23		23				20		15			23			23								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	131	0		29	10	S5884_131_0	2	Non-Preferred Drug	2	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											69.00	36		36				63.00	35		35										36		36				35		30			36			36								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	131	0		29	10	S5884_131_0	2	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	132	0		29	10	S5884_132_0	3	Preferred Generic	2	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0		0.07	0	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	132	0		29	10	S5884_132_0	3	Generic	2	010001	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												
S5884	132	0		29	10	S5884_132_0	3	Preferred Brand	2	010001	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											29.00	25		25				22.00	20		20										25		25				20		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	132	0		29	10	S5884_132_0	3	Non-Preferred Drug	2	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											80.00	45		45				58.00	35		35										45		45				35		30			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	132	0		29	10	S5884_132_0	3	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	133	0		29	10	S5884_133_0	2	Preferred Generic	2	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0		0.07	0	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	133	0		29	10	S5884_133_0	2	Generic	2	010001	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												
S5884	133	0		29	10	S5884_133_0	2	Preferred Brand	2	010001	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											28.00	25		25				21.00	20		20										25		25				20		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	133	0		29	10	S5884_133_0	2	Non-Preferred Drug	2	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											73.00	39		39				61.00	35		35										39		39				35		30			39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	133	0		29	10	S5884_133_0	2	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	134	0		29	10	S5884_134_0	2	Preferred Generic	2	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								4.00		12.00					0.00		0.00											4.00		12.00				0.00		0.00				4.00				4.00			0.13	0		0.13	0	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	134	0		29	10	S5884_134_0	2	Generic	2	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								9.00		27.00					1.00		3.00											9.00		27.00				1.00		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												
S5884	134	0		29	10	S5884_134_0	2	Preferred Brand	2	010001	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											27.00	25		25				20.00	20		20										25		25				20		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	134	0		29	10	S5884_134_0	2	Non-Preferred Drug	2	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											83.00	50		50				52.00	35		35										50		50				35		30			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	134	0		29	10	S5884_134_0	2	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	135	0		29	10	S5884_135_0	2	Preferred Generic	2	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0		0.07	0	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	135	0		29	10	S5884_135_0	2	Generic	2	010001	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												
S5884	135	0		29	10	S5884_135_0	2	Preferred Brand	2	010001	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											26.00	25		25				19.00	20		20										25		25				20		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	135	0		29	10	S5884_135_0	2	Non-Preferred Drug	2	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											82.00	50		50				53.00	35		35										50		50				35		30			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	135	0		29	10	S5884_135_0	2	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	136	0		29	10	S5884_136_0	2	Preferred Generic	2	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0		0.07	0	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	136	0		29	10	S5884_136_0	2	Generic	2	010001	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												
S5884	136	0		29	10	S5884_136_0	2	Preferred Brand	2	010001	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											26.00	25		25				20.00	20		20										25		25				20		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	136	0		29	10	S5884_136_0	2	Non-Preferred Drug	2	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											68.00	37		37				61.00	35		35										37		37				35		30			37			37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	136	0		29	10	S5884_136_0	2	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	137	0		29	10	S5884_137_0	2	Preferred Generic	2	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0		0.07	0	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	137	0		29	10	S5884_137_0	2	Generic	2	010001	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												
S5884	137	0		29	10	S5884_137_0	2	Preferred Brand	2	010001	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											27.00	25		25				21.00	20		20										25		25				20		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	137	0		29	10	S5884_137_0	2	Non-Preferred Drug	2	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											71.00	38		38				61.00	35		35										38		38				35		30			38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	137	0		29	10	S5884_137_0	2	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	138	0		29	10	S5884_138_0	2	Preferred Generic	2	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0		0.07	0	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	138	0		29	10	S5884_138_0	2	Generic	2	010001	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												
S5884	138	0		29	10	S5884_138_0	2	Preferred Brand	2	010001	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											27.00	25		25				20.00	20		20										25		25				20		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	138	0		29	10	S5884_138_0	2	Non-Preferred Drug	2	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											78.00	43		43				58.00	35		35										43		43				35		30			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	138	0		29	10	S5884_138_0	2	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	139	0		29	10	S5884_139_0	2	Preferred Generic	2	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0		0.07	0	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	139	0		29	10	S5884_139_0	2	Generic	2	010001	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												
S5884	139	0		29	10	S5884_139_0	2	Preferred Brand	2	010001	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											26.00	25		25				20.00	20		20										25		25				20		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	139	0		29	10	S5884_139_0	2	Non-Preferred Drug	2	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											70.00	41		41				54.00	35		35										41		41				35		30			41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	139	0		29	10	S5884_139_0	2	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	140	0		29	10	S5884_140_0	2	Preferred Generic	2	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								3.00		9.00					0.00		0.00											3.00		9.00				0.00		0.00				3.00				3.00			0.10	0		0.10	0	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	140	0		29	10	S5884_140_0	2	Generic	2	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								4.00		12.00					1.00		3.00											4.00		12.00				1.00		0.00				4.00				4.00			0.13	0.03		0.13	0.03	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	140	0		29	10	S5884_140_0	2	Preferred Brand	2	010001	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											25.00	25		25				19.00	20		20										25		25				20		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	140	0		29	10	S5884_140_0	2	Non-Preferred Drug	2	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											86.00	49		49				55.00	35		35										49		49				35		30			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	140	0		29	10	S5884_140_0	2	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	141	0		29	10	S5884_141_0	2	Preferred Generic	2	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								5.00		15.00					0.00		0.00											5.00		15.00				0.00		0.00				5.00				5.00			0.17	0		0.17	0	0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	141	0		29	10	S5884_141_0	2	Generic	2	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								9.00		27.00					1.00		3.00											9.00		27.00				1.00		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												
S5884	141	0		29	10	S5884_141_0	2	Preferred Brand	2	010001	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											24.00	25		25				18.00	20		20										25		25				20		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	141	0		29	10	S5884_141_0	2	Non-Preferred Drug	2	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											80.00	50		50				50.00	35		35										50		50				35		30			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	141	0		29	10	S5884_141_0	2	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	142	0		29	10	S5884_142_0	2	Preferred Generic	2	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0		0.07	0	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	142	0		29	10	S5884_142_0	2	Generic	2	010001	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												
S5884	142	0		29	10	S5884_142_0	2	Preferred Brand	2	010001	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											28.00	25		25				21.00	20		20										25		25				20		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	142	0		29	10	S5884_142_0	2	Non-Preferred Drug	2	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											72.00	39		39				60.00	35		35										39		39				35		30			39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	142	0		29	10	S5884_142_0	2	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	143	0		29	10	S5884_143_0	2	Preferred Generic	2	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0		0.07	0	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	143	0		29	10	S5884_143_0	2	Generic	2	010001	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												
S5884	143	0		29	10	S5884_143_0	2	Preferred Brand	2	010001	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											32.00	25		25				23.00	20		20										25		25				20		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	143	0		29	10	S5884_143_0	2	Non-Preferred Drug	2	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											86.00	42		42				65.00	35		35										42		42				35		30			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	143	0		29	10	S5884_143_0	2	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	144	0		29	10	S5884_144_0	2	Preferred Generic	2	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0		0.07	0	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	144	0		29	10	S5884_144_0	2	Generic	2	010001	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												
S5884	144	0		29	10	S5884_144_0	2	Preferred Brand	2	010001	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											26.00	25		25				20.00	20		20										25		25				20		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	144	0		29	10	S5884_144_0	2	Non-Preferred Drug	2	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											76.00	41		41				60.00	35		35										41		41				35		30			41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	144	0		29	10	S5884_144_0	2	Specialty Tier	2	010010	1	1	5	1		010	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	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0		0.07	0	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	145	0		29	10	S5884_145_0	2	Generic	2	010001	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												
S5884	145	0		29	10	S5884_145_0	2	Preferred Brand	2	010001	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											23.00	23		23				19.00	20		20										23		23				20		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	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											63.00	37		37				55.00	35		35										37		37				35		30			37			37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	145	0		29	10	S5884_145_0	2	Specialty Tier	2	010010	1	1	5	1		010	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	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0		0.07	0	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	146	0		29	10	S5884_146_0	2	Generic	2	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								4.00		12.00					1.00		3.00											4.00		12.00				1.00		0.00				4.00				4.00			0.13	0.03		0.13	0.03	0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	146	0		29	10	S5884_146_0	2	Preferred Brand	2	010001	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											30.00	25		25				22.00	20		20										25		25				20		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	146	0		29	10	S5884_146_0	2	Non-Preferred Drug	2	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											83.00	47		47				57.00	35		35										47		47				35		30			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	146	0		29	10	S5884_146_0	2	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	147	0		29	10	S5884_147_0	2	Preferred Generic	2	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								2.00		6.00					0.00		0.00											2.00		6.00				0.00		0.00				2.00				2.00			0.07	0		0.07	0	0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	147	0		29	10	S5884_147_0	2	Generic	2	010001	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												
S5884	147	0		29	10	S5884_147_0	2	Preferred Brand	2	010001	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											25.00	25		25				19.00	20		20										25		25				20		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	147	0		29	10	S5884_147_0	2	Non-Preferred Drug	2	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											67.00	38		38				58.00	35		35										38		38				35		30			38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	147	0		29	10	S5884_147_0	2	Specialty Tier	2	010010	1	1	5	1		010	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	2	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	148	0		29	10	S5884_148_0	2	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		8.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	148	0		29	10	S5884_148_0	2	Preferred Brand	4	010001	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											31.00	25		25				23.00	20		20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	148	0		29	10	S5884_148_0	2	Non-Preferred Drug	4	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											65.00	47		47				41.00	35		35										47		47				35		35			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	148	0		29	10	S5884_148_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	149	0		29	10	S5884_149_0	2	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	149	0		29	10	S5884_149_0	2	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		8.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	149	0		29	10	S5884_149_0	2	Preferred Brand	4	010001	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											31.00	25		25				23.00	20		20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	149	0		29	10	S5884_149_0	2	Non-Preferred Drug	4	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											75.00	50		50				46.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	149	0		29	10	S5884_149_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	150	0		29	10	S5884_150_0	2	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	150	0		29	10	S5884_150_0	2	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		8.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	150	0		29	10	S5884_150_0	2	Preferred Brand	4	010001	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											30.00	25		25				22.00	20		20										25		25				20		18			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	150	0		29	10	S5884_150_0	2	Non-Preferred Drug	4	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											79.00	49		49				51.00	35		35										49		49				35		35			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	150	0		29	10	S5884_150_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	151	0		29	10	S5884_151_0	2	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	151	0		29	10	S5884_151_0	2	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		8.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	151	0		29	10	S5884_151_0	2	Preferred Brand	4	010001	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											32.00	25		25				23.00	20		20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	151	0		29	10	S5884_151_0	2	Non-Preferred Drug	4	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											77.00	50		50				46.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	151	0		29	10	S5884_151_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	152	0		29	10	S5884_152_0	2	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	152	0		29	10	S5884_152_0	2	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		8.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	152	0		29	10	S5884_152_0	2	Preferred Brand	4	010001	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											29.00	25		25				22.00	20		20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	152	0		29	10	S5884_152_0	2	Non-Preferred Drug	4	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											78.00	50		50				47.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	152	0		29	10	S5884_152_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	153	0		29	10	S5884_153_0	2	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	153	0		29	10	S5884_153_0	2	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		8.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	153	0		29	10	S5884_153_0	2	Preferred Brand	4	010001	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											29.00	25		25				21.00	20		20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	153	0		29	10	S5884_153_0	2	Non-Preferred Drug	4	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											73.00	50		50				45.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	153	0		29	10	S5884_153_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	154	0		29	10	S5884_154_0	2	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	154	0		29	10	S5884_154_0	2	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		8.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	154	0		29	10	S5884_154_0	2	Preferred Brand	4	010001	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											28.00	25		25				21.00	20		20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	154	0		29	10	S5884_154_0	2	Non-Preferred Drug	4	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											73.00	50		50				44.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	154	0		29	10	S5884_154_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	155	0		29	10	S5884_155_0	2	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	155	0		29	10	S5884_155_0	2	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		8.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	155	0		29	10	S5884_155_0	2	Preferred Brand	4	010001	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											28.00	25		25				20.00	20		20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	155	0		29	10	S5884_155_0	2	Non-Preferred Drug	4	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											73.00	50		50				43.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	155	0		29	10	S5884_155_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	156	0		29	10	S5884_156_0	2	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	156	0		29	10	S5884_156_0	2	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		8.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	156	0		29	10	S5884_156_0	2	Preferred Brand	4	010001	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											28.00	25		25				21.00	20		20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	156	0		29	10	S5884_156_0	2	Non-Preferred Drug	4	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											68.00	50		50				42.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	156	0		29	10	S5884_156_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	157	0		29	10	S5884_157_0	2	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	157	0		29	10	S5884_157_0	2	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								15.00		45.00					4.00		12.00											15.00		45.00				4.00		8.00				15.00				15.00			0.50	0.13		0.50	0.13	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	157	0		29	10	S5884_157_0	2	Preferred Brand	4	010001	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											27.00	25		25				20.00	20		20										25		25				20		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	157	0		29	10	S5884_157_0	2	Non-Preferred Drug	4	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											75.00	48		48				46.00	35		35										48		48				35		30			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	157	0		29	10	S5884_157_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	158	0		29	10	S5884_158_0	2	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	158	0		29	10	S5884_158_0	2	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		8.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	158	0		29	10	S5884_158_0	2	Preferred Brand	4	010001	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											27.00	25		25				20.00	20		20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	158	0		29	10	S5884_158_0	2	Non-Preferred Drug	4	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											69.00	50		50				43.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	158	0		29	10	S5884_158_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	159	0		29	10	S5884_159_0	2	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	159	0		29	10	S5884_159_0	2	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		8.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	159	0		29	10	S5884_159_0	2	Preferred Brand	4	010001	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											28.00	25		25				21.00	20		20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	159	0		29	10	S5884_159_0	2	Non-Preferred Drug	4	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											78.00	50		50				44.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	159	0		29	10	S5884_159_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	160	0		29	10	S5884_160_0	2	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	160	0		29	10	S5884_160_0	2	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		8.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	160	0		29	10	S5884_160_0	2	Preferred Brand	4	010001	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											28.00	25		25				21.00	20		20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	160	0		29	10	S5884_160_0	2	Non-Preferred Drug	4	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											76.00	50		50				45.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	160	0		29	10	S5884_160_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	161	0		29	10	S5884_161_0	2	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	161	0		29	10	S5884_161_0	2	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		8.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	161	0		29	10	S5884_161_0	2	Preferred Brand	4	010001	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											28.00	25		25				20.00	20		20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	161	0		29	10	S5884_161_0	2	Non-Preferred Drug	4	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											72.00	50		50				44.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	161	0		29	10	S5884_161_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	162	0		29	10	S5884_162_0	2	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	162	0		29	10	S5884_162_0	2	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		8.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	162	0		29	10	S5884_162_0	2	Preferred Brand	4	010001	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											31.00	25		25				23.00	20		20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	162	0		29	10	S5884_162_0	2	Non-Preferred Drug	4	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											68.00	50		50				42.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	162	0		29	10	S5884_162_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	163	0		29	10	S5884_163_0	2	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	163	0		29	10	S5884_163_0	2	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		8.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	163	0		29	10	S5884_163_0	2	Preferred Brand	4	010001	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											31.00	25		25				23.00	20		20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	163	0		29	10	S5884_163_0	2	Non-Preferred Drug	4	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											75.00	50		50				46.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	163	0		29	10	S5884_163_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	164	0		29	10	S5884_164_0	2	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	164	0		29	10	S5884_164_0	2	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		8.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	164	0		29	10	S5884_164_0	2	Preferred Brand	4	010001	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											28.00	25		25				21.00	20		20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	164	0		29	10	S5884_164_0	2	Non-Preferred Drug	4	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											71.00	50		50				41.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	164	0		29	10	S5884_164_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	165	0		29	10	S5884_165_0	2	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	165	0		29	10	S5884_165_0	2	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		8.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	165	0		29	10	S5884_165_0	2	Preferred Brand	4	010001	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											27.00	25		25				20.00	20		20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	165	0		29	10	S5884_165_0	2	Non-Preferred Drug	4	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											66.00	50		50				40.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	165	0		29	10	S5884_165_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	166	0		29	10	S5884_166_0	2	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	166	0		29	10	S5884_166_0	2	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		8.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	166	0		29	10	S5884_166_0	2	Preferred Brand	4	010001	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											27.00	25		25				20.00	20		20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	166	0		29	10	S5884_166_0	2	Non-Preferred Drug	4	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											61.00	50		50				38.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	166	0		29	10	S5884_166_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	167	0		29	10	S5884_167_0	2	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	167	0		29	10	S5884_167_0	2	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		8.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	167	0		29	10	S5884_167_0	2	Preferred Brand	4	010001	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											28.00	25		25				20.00	20		20										25		25				20		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	167	0		29	10	S5884_167_0	2	Non-Preferred Drug	4	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											71.00	50		50				41.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	167	0		29	10	S5884_167_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	168	0		29	10	S5884_168_0	2	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	168	0		29	10	S5884_168_0	2	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		8.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	168	0		29	10	S5884_168_0	2	Preferred Brand	4	010001	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											30.00	25		25				22.00	20		20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	168	0		29	10	S5884_168_0	2	Non-Preferred Drug	4	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											73.00	50		50				45.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	168	0		29	10	S5884_168_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	169	0		29	10	S5884_169_0	2	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	169	0		29	10	S5884_169_0	2	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		8.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	169	0		29	10	S5884_169_0	2	Preferred Brand	4	010001	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											29.00	25		25				21.00	20		20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	169	0		29	10	S5884_169_0	2	Non-Preferred Drug	4	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											70.00	50		50				43.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	169	0		29	10	S5884_169_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	170	0		29	10	S5884_170_0	2	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	170	0		29	10	S5884_170_0	2	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		8.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	170	0		29	10	S5884_170_0	2	Preferred Brand	4	010001	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											29.00	25		25				21.00	20		20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	170	0		29	10	S5884_170_0	2	Non-Preferred Drug	4	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											71.00	50		50				42.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	170	0		29	10	S5884_170_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	171	0		29	10	S5884_171_0	2	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	171	0		29	10	S5884_171_0	2	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		8.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	171	0		29	10	S5884_171_0	2	Preferred Brand	4	010001	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											31.00	25		25				23.00	20		20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	171	0		29	10	S5884_171_0	2	Non-Preferred Drug	4	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											71.00	50		50				44.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	171	0		29	10	S5884_171_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	172	0		29	10	S5884_172_0	2	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	172	0		29	10	S5884_172_0	2	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		8.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	172	0		29	10	S5884_172_0	2	Preferred Brand	4	010001	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											33.00	25		25				24.00	20		20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	172	0		29	10	S5884_172_0	2	Non-Preferred Drug	4	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											60.00	50		50				35.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	172	0		29	10	S5884_172_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	173	0		29	10	S5884_173_0	2	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	173	0		29	10	S5884_173_0	2	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		8.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	173	0		29	10	S5884_173_0	2	Preferred Brand	4	010001	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											29.00	25		25				22.00	20		20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	173	0		29	10	S5884_173_0	2	Non-Preferred Drug	4	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											61.00	50		50				36.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	173	0		29	10	S5884_173_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	174	0		29	10	S5884_174_0	2	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	174	0		29	10	S5884_174_0	2	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		8.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	174	0		29	10	S5884_174_0	2	Preferred Brand	4	010001	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											28.00	25		25				21.00	20		20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	174	0		29	10	S5884_174_0	2	Non-Preferred Drug	4	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											71.00	50		50				44.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	174	0		29	10	S5884_174_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	175	0		29	10	S5884_175_0	2	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		2.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	175	0		29	10	S5884_175_0	2	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		8.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	175	0		29	10	S5884_175_0	2	Preferred Brand	4	010001	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											28.00	25		25				20.00	20		20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	175	0		29	10	S5884_175_0	2	Non-Preferred Drug	4	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											83.00	48		48				53.00	35		35										48		48				35		35			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	175	0		29	10	S5884_175_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	176	0		29	10	S5884_176_0	2	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	176	0		29	10	S5884_176_0	2	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		8.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	176	0		29	10	S5884_176_0	2	Preferred Brand	4	010001	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											27.00	25		25				20.00	20		20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	176	0		29	10	S5884_176_0	2	Non-Preferred Drug	4	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											67.00	50		50				40.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	176	0		29	10	S5884_176_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	177	0		29	10	S5884_177_0	2	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	177	0		29	10	S5884_177_0	2	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		8.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	177	0		29	10	S5884_177_0	2	Preferred Brand	4	010001	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											29.00	25		25				21.00	20		20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	177	0		29	10	S5884_177_0	2	Non-Preferred Drug	4	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											71.00	50		50				43.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	177	0		29	10	S5884_177_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	178	0		29	10	S5884_178_0	2	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	178	0		29	10	S5884_178_0	2	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		8.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	178	0		29	10	S5884_178_0	2	Preferred Brand	4	010001	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											29.00	25		25				21.00	20		20										25		25				20		16			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	178	0		29	10	S5884_178_0	2	Non-Preferred Drug	4	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											77.00	50		50				46.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	178	0		29	10	S5884_178_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	179	0		29	10	S5884_179_0	2	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	179	0		29	10	S5884_179_0	2	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		8.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	179	0		29	10	S5884_179_0	2	Preferred Brand	4	010001	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											37.00	25		25				26.00	20		20										25		25				20		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	179	0		29	10	S5884_179_0	2	Non-Preferred Drug	4	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											58.00	45		45				36.00	35		35										45		45				35		35			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	179	0		29	10	S5884_179_0	2	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	180	0		29	10	S5884_180_0	2	Preferred Generic	4	001010	1	2	1	1		110	01		110	1				30		90	2	2				30		90	30		31								10.00		30.00					1.00		3.00											10.00		30.00				1.00		0.00				10.00				10.00			0.33	0.03		0.33	0.03	0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	180	0		29	10	S5884_180_0	2	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	2	2				30		90	30		31								20.00		60.00					4.00		12.00											20.00		60.00				4.00		8.00				20.00				20.00			0.67	0.13		0.67	0.13	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	180	0		29	10	S5884_180_0	2	Preferred Brand	4	010001	1	1	3	1		110	01		110	1				30		90	2	2				30		90	30		31											31.00	25		25				23.00	20		20										25		25				20		20			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	180	0		29	10	S5884_180_0	2	Non-Preferred Drug	4	110000	1	1	4	1		110	01		110	1				30		90	2	2				30		90	30		31											69.00	50		50				43.00	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5884	180	0		29	10	S5884_180_0	2	Specialty Tier	4	010010	1	1	5	1		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	4	Preferred Generic	3	001000	1	2	1	1		110	01	110		1				31		90	1	1	31		90				31		31								9.00		27.00					2.00		6.00					2.00		6.00																9.00				2.00			0.29	0.06	0.06			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5904	001	0		29	10	S5904_001_0	4	Generic	3	010000	1	2	2	1		110	01	110		1				31		90	1	1	31		90				31		31								20.00		60.00					13.00		39.00					13.00		39.00																20.00				13.00			0.65	0.42	0.42			0.42	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5904	001	0		29	10	S5904_001_0	4	Preferred Brand	3	010001	1	2	3	1		110	01	110		1				31		90	1	1	31		90				31		31								47.00		141.00					40.00		120.00					40.00		120.00																47.00				40.00			1.52	1.29	1.29			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5904	001	0		29	10	S5904_001_0	4	Non-Preferred Brand	3	110000	1	2	4	1		110	01	110		1				31		90	1	1	31		90				31		31								100.00		300.00					93.00		279.00					93.00		279.00																100.00				93.00			3.23	3.00	3.00			3.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5904	001	0		29	10	S5904_001_0	4	Specialty Tier	3	010010	1	1	5	1		010	01	010		1				31					31						31		31											383.38	26						383.38	26						26																	26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5904	002	0		29	10	S5904_002_0	5	Preferred Generic	4	001000	1	2	1	1		110	01	110		1				31		90	1	1	31		90				31		31								10.00		30.00					3.00		9.00					3.00		9.00																10.00				3.00			0.32	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5904	002	0		29	10	S5904_002_0	5	Preferred Generic	4	001000	1	2	1	3		110	01	110		1				31		90	1	1	31		90				31		31								10.00		30.00					3.00		9.00					3.00		9.00																10.00				3.00			0.32	0.10	0.10			0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5904	002	0		29	10	S5904_002_0	5	Generic	4	010000	1	2	2	1		110	01	110		1				31		90	1	1	31		90				31		31								17.00		51.00					10.00		30.00					10.00		30.00																17.00				10.00			0.55	0.32	0.32			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5904	002	0		29	10	S5904_002_0	5	Generic	4	010000	1	2	2	3		110	01	110		1				31		90	1	1	31		90				31		31								17.00		51.00					10.00		30.00					10.00		30.00																17.00				10.00			0.55	0.32	0.32			0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5904	002	0		29	10	S5904_002_0	5	Preferred Brand	4	010001	1	2	3	1		110	01	110		1				31		90	1	1	31		90				31		31								47.00		141.00					40.00		120.00					40.00		120.00																47.00				40.00			1.52	1.29	1.29			1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5904	002	0		29	10	S5904_002_0	5	Non-Preferred Brand	4	110000	1	2	4	1		110	01	110		1				31		90	1	1	31		90				31		31								100.00		300.00					93.00		279.00					93.00		279.00																100.00				93.00			3.23	3.00	3.00			3.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5904	002	0		29	10	S5904_002_0	5	Specialty Tier	4	010010	1	1	5	1		010	01	010		1				31					31						31		31											734.32	33						734.32	33						33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5916	001	0		29	10	S5916_001_0	4	Preferred Generic	3	001000	1	2	1	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	5.00	10.00	10.00																			5.00	10.00	10.00																5.00				5.00		0.17			0.17			0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5916	001	0		29	10	S5916_001_0	4	Generic	3	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	15.00	30.00	30.00																			15.00	30.00	30.00																15.00				15.00		0.50			0.50			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5916	001	0		29	10	S5916_001_0	4	Preferred Brand	3	000001	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, Select Care Drugs												
S5916	001	0		29	10	S5916_001_0	4	Non-Preferred Drug	3	100100	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				76.00	40	40	40																		40	40	40															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5916	001	0		29	10	S5916_001_0	4	Specialty Tier	3	010010	1	1	5	1	010		01	010		1	30								30						30		31				1044.40	28																				28																	28			28								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5916	001	0		29	10	S5916_001_0	4	Select Care Drugs	3	010000	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5916	002	0		29	10	S5916_002_0	4	Preferred Generic	4	001000	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	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5916	002	0		29	10	S5916_002_0	4	Preferred Generic	4	001000	1	2	1	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	2.00	4.00	4.00																			2.00	4.00	4.00																2.00				2.00		0.07			0.07			0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5916	002	0		29	10	S5916_002_0	4	Generic	4	010000	1	2	2	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	4.00	8.00	8.00																			4.00	8.00	8.00																4.00				4.00		0.13			0.13			0.13	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5916	002	0		29	10	S5916_002_0	4	Preferred Brand	4	000001	1	2	3	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	36.00	72.00	90.00																			36.00	72.00	90.00																36.00				36.00		1.20			1.20			1.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5916	002	0		29	10	S5916_002_0	4	Non-Preferred Drug	4	100100	1	1	4	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31				76.00	40	40	40																		40	40	40															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5916	002	0		29	10	S5916_002_0	4	Specialty Tier	4	010010	1	1	5	1	010		01	010		1	30								30						30		31				1230.90	33																				33																	33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5916	002	0		29	10	S5916_002_0	4	Select Care Drugs	4	010000	1	2	6	1	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs												
S5916	002	0		29	10	S5916_002_0	4	Select Care Drugs	4	010000	1	2	6	3	111		01	111		1	30	60	90				1	2	30	60	90				30		31	0.00	0.00	0.00																			0.00	0.00	0.00																0.00				0.00		0.00			0.00			0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier, Select Care Drugs										1		
S5921	348	0		29	10	S5921_348_0	2	Preferred Generic	2	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								2.00		6.00					1.00		3.00													6.00						0.00				2.00				2.00			0.06	0.03				0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	348	0		29	10	S5921_348_0	2	Generic	2	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								7.00		21.00					2.00		6.00													21.00						0.00				7.00				7.00			0.23	0.06				0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	348	0		29	10	S5921_348_0	2	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								30.00		90.00					18.00		54.00													90.00						49.00				30.00				30.00			1.00	0.60				0.96	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	348	0		29	10	S5921_348_0	2	Non-Preferred Drug	2	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											108.00	37		37				88.00	30		30												37						30			37			37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	348	0		29	10	S5921_348_0	2	Specialty Tier	2	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											584.00	25		25				584.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	349	0		29	10	S5921_349_0	2	Preferred Generic	2	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								4.00		12.00					1.00		3.00													12.00						0.00				4.00				4.00			0.13	0.03				0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	349	0		29	10	S5921_349_0	2	Generic	2	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								7.00		21.00					2.00		6.00													21.00						0.00				7.00				7.00			0.23	0.06				0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	349	0		29	10	S5921_349_0	2	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								30.00		90.00					20.00		60.00													90.00						55.00				30.00				30.00			1.00	0.66				0.96	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	349	0		29	10	S5921_349_0	2	Non-Preferred Drug	2	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											107.00	38		38				85.00	30		30												38						30			38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	349	0		29	10	S5921_349_0	2	Specialty Tier	2	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											627.00	25		25				627.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	350	0		29	10	S5921_350_0	2	Preferred Generic	2	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					1.00		3.00													15.00						0.00				5.00				5.00			0.16	0.03				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	350	0		29	10	S5921_350_0	2	Generic	2	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					2.00		6.00													30.00						0.00				10.00				10.00			0.33	0.06				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	350	0		29	10	S5921_350_0	2	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								33.00		99.00					23.00		69.00													99.00						64.00				33.00				33.00			1.10	0.76				1.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	350	0		29	10	S5921_350_0	2	Non-Preferred Drug	2	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											108.00	40		40				81.00	30		30												40						30			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	350	0		29	10	S5921_350_0	2	Specialty Tier	2	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											659.00	25		25				659.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	351	0		29	10	S5921_351_0	2	Preferred Generic	2	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								4.00		12.00					1.00		3.00													12.00						0.00				4.00				4.00			0.13	0.03				0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	351	0		29	10	S5921_351_0	2	Generic	2	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								7.00		21.00					2.00		6.00													21.00						0.00				7.00				7.00			0.23	0.06				0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	351	0		29	10	S5921_351_0	2	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								30.00		90.00					18.00		54.00													90.00						49.00				30.00				30.00			1.00	0.60				0.96	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	351	0		29	10	S5921_351_0	2	Non-Preferred Drug	2	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											108.00	40		40				81.00	30		30												40						30			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	351	0		29	10	S5921_351_0	2	Specialty Tier	2	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											602.00	25		25				602.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	352	0		29	10	S5921_352_0	2	Preferred Generic	2	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								6.00		18.00					1.00		3.00													18.00						0.00				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	2	Generic	2	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								9.00		27.00					2.00		6.00													27.00						0.00				9.00				9.00			0.30	0.06				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	352	0		29	10	S5921_352_0	2	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								39.00		117.00					29.00		87.00													117.00						82.00				39.00				39.00			1.30	0.96				1.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	352	0		29	10	S5921_352_0	2	Non-Preferred Drug	2	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											104.00	40		40				78.00	30		30												40						30			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	352	0		29	10	S5921_352_0	2	Specialty Tier	2	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											634.00	25		25				634.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	353	0		29	10	S5921_353_0	1	Preferred Generic	2	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					1.00		3.00													15.00						0.00				5.00				5.00			0.16	0.03				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	353	0		29	10	S5921_353_0	1	Generic	2	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					2.00		6.00													24.00						0.00				8.00				8.00			0.26	0.06				0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	353	0		29	10	S5921_353_0	1	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								38.00		114.00					20.00		60.00													114.00						55.00				38.00				38.00			1.26	0.66				1.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	353	0		29	10	S5921_353_0	1	Non-Preferred Drug	2	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											105.00	40		40				78.00	30		30												40						30			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	353	0		29	10	S5921_353_0	1	Specialty Tier	2	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											610.00	25		25				610.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	354	0		29	10	S5921_354_0	1	Preferred Generic	2	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								6.00		18.00					1.00		3.00													18.00						0.00				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	1	Generic	2	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								9.00		27.00					2.00		6.00													27.00						0.00				9.00				9.00			0.30	0.06				0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	354	0		29	10	S5921_354_0	1	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								36.00		108.00					20.00		60.00													108.00						55.00				36.00				36.00			1.20	0.66				1.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	354	0		29	10	S5921_354_0	1	Non-Preferred Drug	2	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											100.00	40		40				75.00	30		30												40						30			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	354	0		29	10	S5921_354_0	1	Specialty Tier	2	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											647.00	25		25				647.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	355	0		29	10	S5921_355_0	2	Preferred Generic	2	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					1.00		3.00													15.00						0.00				5.00				5.00			0.16	0.03				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	355	0		29	10	S5921_355_0	2	Generic	2	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					2.00		6.00													24.00						0.00				8.00				8.00			0.26	0.06				0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	355	0		29	10	S5921_355_0	2	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								38.00		114.00					20.00		60.00													114.00						55.00				38.00				38.00			1.26	0.66				1.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	355	0		29	10	S5921_355_0	2	Non-Preferred Drug	2	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											98.00	40		40				73.00	30		30												40						30			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	355	0		29	10	S5921_355_0	2	Specialty Tier	2	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											657.00	25		25				657.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	356	0		29	10	S5921_356_0	3	Preferred Generic	2	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								2.00		6.00					1.00		3.00													6.00						0.00				2.00				2.00			0.06	0.03				0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	356	0		29	10	S5921_356_0	3	Generic	2	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					2.00		6.00													15.00						0.00				5.00				5.00			0.16	0.06				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	356	0		29	10	S5921_356_0	3	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								30.00		90.00					17.00		51.00													90.00						46.00				30.00				30.00			1.00	0.56				0.96	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	356	0		29	10	S5921_356_0	3	Non-Preferred Drug	2	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											98.00	35		35				84.00	30		30												35						30			35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	356	0		29	10	S5921_356_0	3	Specialty Tier	2	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											548.00	25		25				548.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	357	0		29	10	S5921_357_0	2	Preferred Generic	2	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								3.00		9.00					1.00		3.00													9.00						0.00				3.00				3.00			0.10	0.03				0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	357	0		29	10	S5921_357_0	2	Generic	2	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								6.00		18.00					2.00		6.00													18.00						0.00				6.00				6.00			0.20	0.06				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	357	0		29	10	S5921_357_0	2	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								36.00		108.00					26.00		78.00													108.00						73.00				36.00				36.00			1.20	0.86				1.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	357	0		29	10	S5921_357_0	2	Non-Preferred Drug	2	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											95.00	40		40				72.00	30		30												40						30			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	357	0		29	10	S5921_357_0	2	Specialty Tier	2	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											662.00	25		25				662.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	358	0		29	10	S5921_358_0	2	Preferred Generic	2	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								2.00		6.00					1.00		3.00													6.00						0.00				2.00				2.00			0.06	0.03				0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	358	0		29	10	S5921_358_0	2	Generic	2	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								7.00		21.00					2.00		6.00													21.00						0.00				7.00				7.00			0.23	0.06				0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	358	0		29	10	S5921_358_0	2	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								32.00		96.00					18.00		54.00													96.00						49.00				32.00				32.00			1.06	0.60				1.03	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	358	0		29	10	S5921_358_0	2	Non-Preferred Drug	2	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											97.00	35		35				91.00	30		30												35						30			35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	358	0		29	10	S5921_358_0	2	Specialty Tier	2	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											601.00	25		25				601.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	359	0		29	10	S5921_359_0	2	Preferred Generic	2	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								3.00		9.00					1.00		3.00													9.00						0.00				3.00				3.00			0.10	0.03				0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	359	0		29	10	S5921_359_0	2	Generic	2	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					2.00		6.00													24.00						0.00				8.00				8.00			0.26	0.06				0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	359	0		29	10	S5921_359_0	2	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								38.00		114.00					28.00		84.00													114.00						79.00				38.00				38.00			1.26	0.93				1.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	359	0		29	10	S5921_359_0	2	Non-Preferred Drug	2	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											109.00	40		40				82.00	30		30												40						30			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	359	0		29	10	S5921_359_0	2	Specialty Tier	2	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											632.00	25		25				632.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	360	0		29	10	S5921_360_0	2	Preferred Generic	2	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								3.00		9.00					1.00		3.00													9.00						0.00				3.00				3.00			0.10	0.03				0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	360	0		29	10	S5921_360_0	2	Generic	2	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					4.00		12.00													30.00						0.00				10.00				10.00			0.33	0.13				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	360	0		29	10	S5921_360_0	2	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								35.00		105.00					25.00		75.00													105.00						70.00				35.00				35.00			1.16	0.83				1.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	360	0		29	10	S5921_360_0	2	Non-Preferred Drug	2	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											106.00	40		40				79.00	30		30												40						30			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	360	0		29	10	S5921_360_0	2	Specialty Tier	2	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											650.00	25		25				650.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	361	0		29	10	S5921_361_0	3	Preferred Generic	2	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								3.00		9.00					1.00		3.00													9.00						0.00				3.00				3.00			0.10	0.03				0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	361	0		29	10	S5921_361_0	3	Generic	2	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					2.00		6.00													24.00						0.00				8.00				8.00			0.26	0.06				0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	361	0		29	10	S5921_361_0	3	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								40.00		120.00					28.00		84.00													120.00						79.00				40.00				40.00			1.33	0.93				1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	361	0		29	10	S5921_361_0	3	Non-Preferred Drug	2	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											97.00	35		35				91.00	30		30												35						30			35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	361	0		29	10	S5921_361_0	3	Specialty Tier	2	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											624.00	25		25				624.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	362	0		29	10	S5921_362_0	2	Preferred Generic	2	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								3.00		9.00					1.00		3.00													9.00						0.00				3.00				3.00			0.10	0.03				0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	362	0		29	10	S5921_362_0	2	Generic	2	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								6.00		18.00					2.00		6.00													18.00						0.00				6.00				6.00			0.20	0.06				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	362	0		29	10	S5921_362_0	2	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								38.00		114.00					27.00		81.00													114.00						76.00				38.00				38.00			1.26	0.90				1.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	362	0		29	10	S5921_362_0	2	Non-Preferred Drug	2	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											104.00	40		40				78.00	30		30												40						30			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	362	0		29	10	S5921_362_0	2	Specialty Tier	2	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											619.00	25		25				619.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	363	0		29	10	S5921_363_0	1	Preferred Generic	2	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								3.00		9.00					1.00		3.00													9.00						0.00				3.00				3.00			0.10	0.03				0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	363	0		29	10	S5921_363_0	1	Generic	2	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					2.00		6.00													24.00						0.00				8.00				8.00			0.26	0.06				0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	363	0		29	10	S5921_363_0	1	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								38.00		114.00					25.00		75.00													114.00						70.00				38.00				38.00			1.26	0.83				1.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	363	0		29	10	S5921_363_0	1	Non-Preferred Drug	2	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											108.00	40		40				81.00	30		30												40						30			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	363	0		29	10	S5921_363_0	1	Specialty Tier	2	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											677.00	25		25				677.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	364	0		29	10	S5921_364_0	1	Preferred Generic	2	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								3.00		9.00					1.00		3.00													9.00						0.00				3.00				3.00			0.10	0.03				0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	364	0		29	10	S5921_364_0	1	Generic	2	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					3.00		9.00													24.00						0.00				8.00				8.00			0.26	0.10				0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	364	0		29	10	S5921_364_0	1	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								31.00		93.00					21.00		63.00													93.00						58.00				31.00				31.00			1.03	0.70				1.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	364	0		29	10	S5921_364_0	1	Non-Preferred Drug	2	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											96.00	40		40				72.00	30		30												40						30			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	364	0		29	10	S5921_364_0	1	Specialty Tier	2	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											748.00	25		25				748.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	365	0		29	10	S5921_365_0	2	Preferred Generic	2	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								4.00		12.00					1.00		3.00													12.00						0.00				4.00				4.00			0.13	0.03				0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	365	0		29	10	S5921_365_0	2	Generic	2	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					2.00		6.00													24.00						0.00				8.00				8.00			0.26	0.06				0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	365	0		29	10	S5921_365_0	2	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								38.00		114.00					20.00		60.00													114.00						55.00				38.00				38.00			1.26	0.66				1.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	365	0		29	10	S5921_365_0	2	Non-Preferred Drug	2	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											91.00	40		40				69.00	30		30												40						30			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	365	0		29	10	S5921_365_0	2	Specialty Tier	2	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											657.00	25		25				657.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	366	0		29	10	S5921_366_0	2	Preferred Generic	2	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								4.00		12.00					1.00		3.00													12.00						0.00				4.00				4.00			0.13	0.03				0.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	366	0		29	10	S5921_366_0	2	Generic	2	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					2.00		6.00													24.00						0.00				8.00				8.00			0.26	0.06				0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	366	0		29	10	S5921_366_0	2	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								30.00		90.00					19.00		57.00													90.00						52.00				30.00				30.00			1.00	0.63				0.96	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	366	0		29	10	S5921_366_0	2	Non-Preferred Drug	2	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											95.00	40		40				71.00	30		30												40						30			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	366	0		29	10	S5921_366_0	2	Specialty Tier	2	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											636.00	25		25				636.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	367	0		29	10	S5921_367_0	2	Preferred Generic	2	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					1.00		3.00													15.00						0.00				5.00				5.00			0.16	0.03				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	367	0		29	10	S5921_367_0	2	Generic	2	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					2.00		6.00													24.00						0.00				8.00				8.00			0.26	0.06				0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	367	0		29	10	S5921_367_0	2	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								42.00		126.00					28.00		84.00													126.00						79.00				42.00				42.00			1.40	0.93				1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	367	0		29	10	S5921_367_0	2	Non-Preferred Drug	2	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											105.00	40		40				79.00	30		30												40						30			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	367	0		29	10	S5921_367_0	2	Specialty Tier	2	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											661.00	25		25				661.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	368	0		29	10	S5921_368_0	1	Preferred Generic	2	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								3.00		9.00					1.00		3.00													9.00						0.00				3.00				3.00			0.10	0.03				0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	368	0		29	10	S5921_368_0	1	Generic	2	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								7.00		21.00					2.00		6.00													21.00						0.00				7.00				7.00			0.23	0.06				0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	368	0		29	10	S5921_368_0	1	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								33.00		99.00					23.00		69.00													99.00						64.00				33.00				33.00			1.10	0.76				1.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	368	0		29	10	S5921_368_0	1	Non-Preferred Drug	2	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											94.00	40		40				71.00	30		30												40						30			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	368	0		29	10	S5921_368_0	1	Specialty Tier	2	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											628.00	25		25				628.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	369	0		29	10	S5921_369_0	2	Preferred Generic	2	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								3.00		9.00					1.00		3.00													9.00						0.00				3.00				3.00			0.10	0.03				0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	369	0		29	10	S5921_369_0	2	Generic	2	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					2.00		6.00													24.00						0.00				8.00				8.00			0.26	0.06				0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	369	0		29	10	S5921_369_0	2	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								35.00		105.00					25.00		75.00													105.00						70.00				35.00				35.00			1.16	0.83				1.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	369	0		29	10	S5921_369_0	2	Non-Preferred Drug	2	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											110.00	40		40				82.00	30		30												40						30			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	369	0		29	10	S5921_369_0	2	Specialty Tier	2	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											592.00	25		25				592.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	370	0		29	10	S5921_370_0	3	Preferred Generic	2	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								6.00		18.00					1.00		3.00													18.00						0.00				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	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								10.00		30.00					2.00		6.00													30.00						0.00				10.00				10.00			0.33	0.06				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	370	0		29	10	S5921_370_0	3	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								43.00		129.00					26.00		78.00													129.00						73.00				43.00				43.00			1.43	0.86				1.38	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	370	0		29	10	S5921_370_0	3	Non-Preferred Drug	2	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											99.00	35		35				93.00	30		30												35						30			35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	370	0		29	10	S5921_370_0	3	Specialty Tier	2	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											491.00	25		25				491.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	371	0		29	10	S5921_371_0	1	Preferred Generic	2	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								3.00		9.00					1.00		3.00													9.00						0.00				3.00				3.00			0.10	0.03				0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	371	0		29	10	S5921_371_0	1	Generic	2	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					2.00		6.00													15.00						0.00				5.00				5.00			0.16	0.06				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	371	0		29	10	S5921_371_0	1	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								35.00		105.00					24.00		72.00													105.00						67.00				35.00				35.00			1.16	0.80				1.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	371	0		29	10	S5921_371_0	1	Non-Preferred Drug	2	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											101.00	40		40				76.00	30		30												40						30			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	371	0		29	10	S5921_371_0	1	Specialty Tier	2	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											533.00	25		25				533.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	372	0		29	10	S5921_372_0	3	Preferred Generic	2	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								3.00		9.00					1.00		3.00													9.00						0.00				3.00				3.00			0.10	0.03				0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	372	0		29	10	S5921_372_0	3	Generic	2	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								7.00		21.00					2.00		6.00													21.00						0.00				7.00				7.00			0.23	0.06				0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	372	0		29	10	S5921_372_0	3	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								45.00		135.00					25.00		75.00													135.00						70.00				45.00				45.00			1.50	0.83				1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	372	0		29	10	S5921_372_0	3	Non-Preferred Drug	2	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											98.00	35		35				92.00	30		30												35						30			35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	372	0		29	10	S5921_372_0	3	Specialty Tier	2	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											563.00	25		25				563.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	373	0		29	10	S5921_373_0	2	Preferred Generic	2	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								3.00		9.00					1.00		3.00													9.00						0.00				3.00				3.00			0.10	0.03				0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	373	0		29	10	S5921_373_0	2	Generic	2	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								6.00		18.00					2.00		6.00													18.00						0.00				6.00				6.00			0.20	0.06				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	373	0		29	10	S5921_373_0	2	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								36.00		108.00					23.00		69.00													108.00						64.00				36.00				36.00			1.20	0.76				1.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	373	0		29	10	S5921_373_0	2	Non-Preferred Drug	2	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											102.00	40		40				77.00	30		30												40						30			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	373	0		29	10	S5921_373_0	2	Specialty Tier	2	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											629.00	25		25				629.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	374	0		29	10	S5921_374_0	2	Preferred Generic	2	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								3.00		9.00					1.00		3.00													9.00						0.00				3.00				3.00			0.10	0.03				0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	374	0		29	10	S5921_374_0	2	Generic	2	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					2.00		6.00													15.00						0.00				5.00				5.00			0.16	0.06				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	374	0		29	10	S5921_374_0	2	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								35.00		105.00					25.00		75.00													105.00						70.00				35.00				35.00			1.16	0.83				1.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	374	0		29	10	S5921_374_0	2	Non-Preferred Drug	2	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											100.00	40		40				75.00	30		30												40						30			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	374	0		29	10	S5921_374_0	2	Specialty Tier	2	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											602.00	25		25				602.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	375	0		29	10	S5921_375_0	2	Preferred Generic	2	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								3.00		9.00					1.00		3.00													9.00						0.00				3.00				3.00			0.10	0.03				0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	375	0		29	10	S5921_375_0	2	Generic	2	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								5.00		15.00					2.00		6.00													15.00						0.00				5.00				5.00			0.16	0.06				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	375	0		29	10	S5921_375_0	2	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								35.00		105.00					25.00		75.00													105.00						70.00				35.00				35.00			1.16	0.83				1.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	375	0		29	10	S5921_375_0	2	Non-Preferred Drug	2	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											99.00	40		40				74.00	30		30												40						30			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	375	0		29	10	S5921_375_0	2	Specialty Tier	2	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											614.00	25		25				614.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	376	0		29	10	S5921_376_0	2	Preferred Generic	2	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								3.00		9.00					1.00		3.00													9.00						0.00				3.00				3.00			0.10	0.03				0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	376	0		29	10	S5921_376_0	2	Generic	2	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								6.00		18.00					2.00		6.00													18.00						0.00				6.00				6.00			0.20	0.06				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	376	0		29	10	S5921_376_0	2	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								31.00		93.00					21.00		63.00													93.00						58.00				31.00				31.00			1.03	0.70				1.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	376	0		29	10	S5921_376_0	2	Non-Preferred Drug	2	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											104.00	36		36				87.00	30		30												36						30			36			36								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	376	0		29	10	S5921_376_0	2	Specialty Tier	2	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											629.00	25		25				629.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	377	0		29	10	S5921_377_0	2	Preferred Generic	2	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								3.00		9.00					1.00		3.00													9.00						0.00				3.00				3.00			0.10	0.03				0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	377	0		29	10	S5921_377_0	2	Generic	2	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								6.00		18.00					2.00		6.00													18.00						0.00				6.00				6.00			0.20	0.06				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	377	0		29	10	S5921_377_0	2	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								35.00		105.00					25.00		75.00													105.00						70.00				35.00				35.00			1.16	0.83				1.12	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	377	0		29	10	S5921_377_0	2	Non-Preferred Drug	2	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											93.00	40		40				70.00	30		30												40						30			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	377	0		29	10	S5921_377_0	2	Specialty Tier	2	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											507.00	25		25				507.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	378	0		29	10	S5921_378_0	2	Preferred Generic	2	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								3.00		9.00					1.00		3.00													9.00						0.00				3.00				3.00			0.10	0.03				0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	378	0		29	10	S5921_378_0	2	Generic	2	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								7.00		21.00					2.00		6.00													21.00						0.00				7.00				7.00			0.23	0.06				0.22	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	378	0		29	10	S5921_378_0	2	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								37.00		111.00					27.00		81.00													111.00						76.00				37.00				37.00			1.23	0.90				1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	378	0		29	10	S5921_378_0	2	Non-Preferred Drug	2	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											110.00	40		40				83.00	30		30												40						30			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	378	0		29	10	S5921_378_0	2	Specialty Tier	2	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											512.00	25		25				512.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	379	0		29	10	S5921_379_0	2	Preferred Generic	2	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								2.00		6.00					1.00		3.00													6.00						0.00				2.00				2.00			0.06	0.03				0.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	379	0		29	10	S5921_379_0	2	Generic	2	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								6.00		18.00					2.00		6.00													18.00						0.00				6.00				6.00			0.20	0.06				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	379	0		29	10	S5921_379_0	2	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								30.00		90.00					20.00		60.00													90.00						55.00				30.00				30.00			1.00	0.66				0.96	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	379	0		29	10	S5921_379_0	2	Non-Preferred Drug	2	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											106.00	35		35				88.00	29		29												35						29			35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	379	0		29	10	S5921_379_0	2	Specialty Tier	2	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											716.00	25		25				716.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	380	0		29	10	S5921_380_0	1	Preferred Generic	2	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								8.00		24.00					1.00		3.00													24.00						0.00				8.00				8.00			0.26	0.03				0.25	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	380	0		29	10	S5921_380_0	1	Generic	2	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					2.00		6.00													45.00						0.00				15.00				15.00			0.50	0.06				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	380	0		29	10	S5921_380_0	1	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								40.00		120.00					30.00		90.00													120.00						85.00				40.00				40.00			1.33	1.00				1.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	380	0		29	10	S5921_380_0	1	Non-Preferred Drug	2	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											109.00	40		40				82.00	30		30												40						30			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	380	0		29	10	S5921_380_0	1	Specialty Tier	2	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											624.00	25		25				624.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	381	0		29	10	S5921_381_0	2	Preferred Generic	2	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								3.00		9.00					1.00		3.00													9.00						0.00				3.00				3.00			0.10	0.03				0.09	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	381	0		29	10	S5921_381_0	2	Generic	2	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								6.00		18.00					2.00		6.00													18.00						0.00				6.00				6.00			0.20	0.06				0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	381	0		29	10	S5921_381_0	2	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								36.00		108.00					21.00		63.00													108.00						58.00				36.00				36.00			1.20	0.70				1.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	381	0		29	10	S5921_381_0	2	Non-Preferred Drug	2	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											104.00	37		37				84.00	30		30												37						30			37			37								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	381	0		29	10	S5921_381_0	2	Specialty Tier	2	010010	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											832.00	25		25				832.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	382	0		29	10	S5921_382_0	4	Preferred Generic	4	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	382	0		29	10	S5921_382_0	4	Generic	4	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								18.00		54.00					3.00		9.00													54.00						9.00				18.00				18.00			0.60	0.10				0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	382	0		29	10	S5921_382_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					27.00		81.00													141.00						81.00				47.00				47.00			1.56	0.90				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	382	0		29	10	S5921_382_0	4	Non-Preferred Drug	4	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											93.00	33		33				90.00	32		32												33						32			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	382	0		29	10	S5921_382_0	4	Specialty Tier	4	010001	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											750.00	25		25				750.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	383	0		29	10	S5921_383_0	4	Preferred Generic	4	001000	1	2	1	1		110	01		100	1				30		90	1	2						90	30		31								15.00		45.00					0.00		0.00													45.00						0.00				15.00				15.00			0.50	0.00				0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	383	0		29	10	S5921_383_0	4	Generic	4	010000	1	2	2	1		110	01		100	1				30		90	1	2						90	30		31								18.00		54.00					3.00		9.00													54.00						9.00				18.00				18.00			0.60	0.10				0.58	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	383	0		29	10	S5921_383_0	4	Preferred Brand	4	010001	1	2	3	1		110	01		100	1				30		90	1	2						90	30		31								47.00		141.00					27.00		81.00													141.00						81.00				47.00				47.00			1.56	0.90				1.51	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	383	0		29	10	S5921_383_0	4	Non-Preferred Drug	4	100100	1	1	4	1		110	01		100	1				30		90	1	2						90	30		31											94.00	33		33				91.00	32		32												33						32			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5921	383	0		29	10	S5921_383_0	4	Specialty Tier	4	010001	1	1	5	1		110	01		100	1				30		90	1	2						90	30		31											763.00	25		25				763.00	25		25												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5953	001	0		29	10	S5953_001_0	3	Preferred Generic	3	001001	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								8.00	16.00	24.00					3.00	6.00	9.00											8.00	16.00	24.00				3.00	6.00	7.50				8.00				3.00			0.27	0.10		0.27	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5953	001	0		29	10	S5953_001_0	3	Generic	3	010001	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	60.00					15.00	30.00	45.00											20.00	40.00	60.00				15.00	30.00	37.50				20.00				15.00			0.67	0.50		0.67	0.50	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5953	001	0		29	10	S5953_001_0	3	Preferred Brand	3	000101	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								47.00	94.00	141.00					37.00	74.00	111.00											47.00	94.00	141.00				37.00	74.00	92.50				47.00				37.00			1.57	1.23		1.57	1.23	1.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5953	001	0		29	10	S5953_001_0	3	Non-Preferred Drug	3	100100	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											45.71	50	50	50				41.14	45	45	45										50	50	50				45	45	45			50			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5953	001	0		29	10	S5953_001_0	3	Specialty Tier	3	010010	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												31	31	31					31	31	31										31	31	31				31	31	31			31			31								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5953	002	0		29	10	S5953_002_0	3	Preferred Generic	4	001001	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				0.00			0.17	0.00		0.17	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5953	002	0		29	10	S5953_002_0	3	Preferred Generic	4	001001	1	2	1	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								5.00	10.00	15.00					0.00	0.00	0.00											5.00	10.00	15.00				0.00	0.00	0.00				5.00				0.00			0.17	0.00		0.17	0.00	0.00	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5953	002	0		29	10	S5953_002_0	3	Generic	4	010001	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					3.00	6.00	9.00											10.00	20.00	30.00				3.00	6.00	7.50				10.00				3.00			0.33	0.10		0.33	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5953	002	0		29	10	S5953_002_0	3	Generic	4	010001	1	2	2	3		111	01		111	1				30	60	90	1	2				30	60	90	30		31								10.00	20.00	30.00					3.00	6.00	9.00											10.00	20.00	30.00				3.00	6.00	7.50				10.00				3.00			0.33	0.10		0.33	0.10	0.10	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier										1		
S5953	002	0		29	10	S5953_002_0	3	Preferred Brand	4	000101	1	2	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								30.00	60.00	90.00					20.00	40.00	60.00											30.00	60.00	90.00				20.00	40.00	50.00				30.00				20.00			1.00	0.67		1.00	0.67	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5953	002	0		29	10	S5953_002_0	3	Non-Preferred Drug	4	100100	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											46.72	45	45	45				41.53	40	40	40										45	45	45				40	40	40			45			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5953	002	0		29	10	S5953_002_0	3	Specialty Tier	4	010010	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												33	33	33					33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5983	004	0		29	10	S5983_004_0	2	Preferred Generic	2	001010	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								5.00		15.00					0.00		0.00													8.00						3.00				5.00				5.00			0.16	0.00				0.16	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5983	004	0		29	10	S5983_004_0	2	Generic	2	010010	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					3.00		9.00													11.00						6.00				10.00				10.00			0.32	0.10				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5983	004	0		29	10	S5983_004_0	2	Preferred Brand	2	010001	1	2	3	1		110	01		100	1				31		90	1	2						90	31		31								46.00		138.00					41.00		123.00													128.00						123.00				46.00				46.00			1.48	1.32				1.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5983	004	0		29	10	S5983_004_0	2	Non-Preferred Drug	2	100100	1	1	4	1		010	01		010	1				31								31			31		31											60.05	50						57.72	48												50						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5983	004	0		29	10	S5983_004_0	2	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				31								31			31		31												25							25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5983	006	0		29	10	S5983_006_0	1	Preferred Generic	4	001010	1	2	1	1		110	01		100	1				31		90	1	2						90	31		31								10.00		30.00					2.00		6.00													5.00						0.00				10.00				10.00			0.32	0.06				0.32	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5983	006	0		29	10	S5983_006_0	1	Generic	4	010010	1	2	2	1		110	01		100	1				31		90	1	2						90	31		31								20.00		60.00					7.00		21.00													9.00						4.00				20.00				20.00			0.65	0.23				0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5983	006	0		29	10	S5983_006_0	1	Preferred Brand	4	010001	1	1	3	1		110	01		100	1				31		90	1	2						90	31		31											63.94	25		25				60.08	23		23												25						25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5983	006	0		29	10	S5983_006_0	1	Non-Preferred Drug	4	100100	1	1	4	1		010	01		010	1				31								31			31		31											56.63	50						50.92	48												50						50					50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5983	006	0		29	10	S5983_006_0	1	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				31								31			31		31												26							26												26						26					26			26								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S5993	001	0		29	10	S5993_001_0	5	Preferred Generic	2	001000	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					3.00	6.00	9.00																6.00				6.00			0.20	0.00	0.10			0.19	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5993	001	0		29	10	S5993_001_0	5	Generic	2	010000	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					7.00	14.00	21.00																14.00				14.00			0.47	0.30	0.23			0.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5993	001	0		29	10	S5993_001_0	5	Preferred Brand	2	010001	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																45.00				45.00			1.50	1.17	1.50			1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5993	001	0		29	10	S5993_001_0	5	Non-Preferred Brand	2	110000	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											39.57	40	40	40				22.26	30	30	30				40	40	40															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5993	001	0		29	10	S5993_001_0	5	Specialty Tier	2	010010	1	1	5	1		010	01			1				30											30		31											159.85	25						159.85	25																							25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5993	003	0		29	10	S5993_003_0	5	Preferred Generic	4	001000	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					3.50	7.00	10.50																7.00				7.00			0.23	0.00	0.12			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5993	003	0		29	10	S5993_003_0	5	Preferred Generic	4	001000	1	2	1	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								7.00	14.00	21.00					0.00	0.00	0.00					3.50	7.00	10.50																7.00				7.00			0.23	0.00	0.12			0.23	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5993	003	0		29	10	S5993_003_0	5	Generic	4	010000	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					7.50	15.00	22.50																15.00				15.00			0.50	0.33	0.25			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5993	003	0		29	10	S5993_003_0	5	Generic	4	010000	1	2	2	3		111	01	111		1				30	60	90	1	2	30	60	90				30		31								15.00	30.00	45.00					10.00	20.00	30.00					7.50	15.00	22.50																15.00				15.00			0.50	0.33	0.25			0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier										1		
S5993	003	0		29	10	S5993_003_0	5	Preferred Brand	4	010001	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																42.00				42.00			1.40	1.07	1.40			1.35	Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5993	003	0		29	10	S5993_003_0	5	Non-Preferred Brand	4	110000	1	1	4	1		111	01	111		1				30	60	90	1	2	30	60	90				30		31											46.10	40	40	40				25.93	30	30	30				40	40	40															40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S5993	003	0		29	10	S5993_003_0	5	Specialty Tier	4	010010	1	1	5	1		010	01			1				30											30		31											350.74	33						350.74	33																							33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, Specialty Tier												
S6506	001	0		29	10	S6506_001_0	2	Preferred Generic	3	001001	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												
S6506	001	0		29	10	S6506_001_0	2	Generic	3	010001	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	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												
S6506	001	0		29	10	S6506_001_0	2	Preferred Brand	3	000101	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											32.84	22	22	22				22.36	15	15	15										22	22	22				15	15	15			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6506	001	0		29	10	S6506_001_0	2	Non-Preferred Drug	3	100100	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											66.65	45	45	45				59.15	40	40	40										45	45	45				40	40	40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6506	001	0		29	10	S6506_001_0	2	Specialty Tier	3	010010	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												25	25	25					25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6506	002	0		29	10	S6506_002_0	2	Preferred Generic	4	001001	1	2	1	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								15.00	30.00	37.50					1.00	2.00	2.50											15.00	30.00	37.50				1.00	2.00	2.50				15.00				15.00			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6506	002	0		29	10	S6506_002_0	2	Generic	4	010001	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	50.00					5.00	10.00	12.50											20.00	40.00	50.00				5.00	10.00	12.50				20.00				20.00			0.67	0.17		0.67	0.17	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6506	002	0		29	10	S6506_002_0	2	Preferred Brand	4	000101	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											51.62	25	25	25				45.64	18	18	18										25	25	25				18	18	18			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6506	002	0		29	10	S6506_002_0	2	Non-Preferred Drug	4	100100	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											88.34	50	50	50				97.57	45	45	45										50	50	50				45	45	45			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6506	002	0		29	10	S6506_002_0	2	Specialty Tier	4	010010	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												33	33	33					33	33	33										33	33	33				33	33	33			33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6986	001	0		29	10	S6986_001_0	3	Preferred Generic	3	001001	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												
S6986	001	0		29	10	S6986_001_0	3	Generic	3	010001	1	2	2	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31								20.00	40.00	40.00					2.00	4.00	4.00											20.00	40.00	40.00				2.00	4.00	4.00				20.00				20.00			0.67	0.07		0.67	0.07	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6986	001	0		29	10	S6986_001_0	3	Preferred Brand	3	000101	1	1	3	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											27.18	22	22	22				18.47	15	15	15										22	22	22				15	15	15			22			22								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6986	001	0		29	10	S6986_001_0	3	Non-Preferred Drug	3	100100	1	1	4	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31											51.76	45	45	45				45.85	40	40	40										45	45	45				40	40	40			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S6986	001	0		29	10	S6986_001_0	3	Specialty Tier	3	010010	1	1	5	1		111	01		111	1				30	60	90	1	2				30	60	90	30		31												25	25	25					25	25	25										25	25	25				25	25	25			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	001	0		29	10	S7694_001_0	5	Preferred Generic	3	001000	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								14.90		44.70					1.00		3.00											14.90		44.70				1.00		2.00				14.90				14.90			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	001	0		29	10	S7694_001_0	5	Generic	3	010000	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		45.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	001	0		29	10	S7694_001_0	5	Preferred Brand	3	010001	1	1	3	1		110	01		110	1				30		90	1	2				30		90	30		31											52.58	20		20				26.29	10		10										20		20				10		10			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	001	0		29	10	S7694_001_0	5	Non-Preferred Drug	3	100100	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											60.74	42		42				39.04	27		27										42		42				27		27			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	001	0		29	10	S7694_001_0	5	Specialty Tier	3	010010	1	1	5	1		010	01		010	1				30								30			30		31											1163.75	27						1163.75	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	002	0		29	10	S7694_002_0	4	Preferred Generic	3	001000	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								14.90		44.70					1.00		3.00											14.90		44.70				1.00		2.00				14.90				14.90			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	002	0		29	10	S7694_002_0	4	Generic	3	010000	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		45.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	002	0		29	10	S7694_002_0	4	Preferred Brand	3	010001	1	1	3	1		110	01		110	1				30		90	1	2				30		90	30		31											59.13	20		20				29.56	10		10										20		20				10		10			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	002	0		29	10	S7694_002_0	4	Non-Preferred Drug	3	100100	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											50.63	34		34				37.23	25		25										34		34				25		25			34			34								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	002	0		29	10	S7694_002_0	4	Specialty Tier	3	010010	1	1	5	1		010	01		010	1				30								30			30		31											838.37	27						838.37	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	003	0		29	10	S7694_003_0	4	Preferred Generic	3	001000	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								14.90		44.70					1.00		3.00											14.90		44.70				1.00		2.00				14.90				14.90			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	003	0		29	10	S7694_003_0	4	Generic	3	010000	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		45.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	003	0		29	10	S7694_003_0	4	Preferred Brand	3	010001	1	1	3	1		110	01		110	1				30		90	1	2				30		90	30		31											58.02	20		20				29.01	10		10										20		20				10		10			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	003	0		29	10	S7694_003_0	4	Non-Preferred Drug	3	100100	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											60.67	41		41				36.99	25		25										41		41				25		25			41			41								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	003	0		29	10	S7694_003_0	4	Specialty Tier	3	010010	1	1	5	1		010	01		010	1				30								30			30		31											834.05	27						834.05	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	004	0		29	10	S7694_004_0	4	Preferred Generic	2	001000	1	1	1	1		110	01		110	1				30		90	1	2				30		90	30		31											1.47	15		15				.83	10		10										15		15				10		10			15			15								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	004	0		29	10	S7694_004_0	4	Generic	2	010000	1	1	2	1		110	01		110	1				30		90	1	2				30		90	30		31											3.17	17		17				2.12	12		12										17		17				12		12			17			17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	004	0		29	10	S7694_004_0	4	Preferred Brand	2	000001	1	1	3	1		110	01		110	1				30		90	1	2				30		90	30		31											79.70	25		25				47.82	15		15										25		25				15		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	004	0		29	10	S7694_004_0	4	Non-Preferred Drug	2	100100	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											58.06	45		45				42.58	33		33										45		45				33		33			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	004	0		29	10	S7694_004_0	4	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				30								30			30		31											674.74	25						674.74	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	005	0		29	10	S7694_005_0	4	Preferred Generic	3	001000	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								14.90		44.70					1.00		3.00											14.90		44.70				1.00		2.00				14.90				14.90			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	005	0		29	10	S7694_005_0	4	Generic	3	010000	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		45.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	005	0		29	10	S7694_005_0	4	Preferred Brand	3	010001	1	1	3	1		110	01		110	1				30		90	1	2				30		90	30		31											56.70	20		20				28.35	10		10										20		20				10		10			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	005	0		29	10	S7694_005_0	4	Non-Preferred Drug	3	100100	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											55.10	39		39				35.32	25		25										39		39				25		25			39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	005	0		29	10	S7694_005_0	4	Specialty Tier	3	010010	1	1	5	1		010	01		010	1				30								30			30		31											798.40	27						798.40	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	006	0		29	10	S7694_006_0	4	Preferred Generic	3	001000	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								14.90		44.70					1.00		3.00											14.90		44.70				1.00		2.00				14.90				14.90			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	006	0		29	10	S7694_006_0	4	Generic	3	010000	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		45.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	006	0		29	10	S7694_006_0	4	Preferred Brand	3	010001	1	1	3	1		110	01		110	1				30		90	1	2				30		90	30		31											58.80	20		20				29.40	10		10										20		20				10		10			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	006	0		29	10	S7694_006_0	4	Non-Preferred Drug	3	100100	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											46.21	32		32				36.10	25		25										32		32				25		25			32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	006	0		29	10	S7694_006_0	4	Specialty Tier	3	010010	1	1	5	1		010	01		010	1				30								30			30		31											921.56	27						921.56	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	007	0		29	10	S7694_007_0	4	Preferred Generic	2	001000	1	1	1	1		110	01		110	1				30		90	1	2				30		90	30		31											1.46	15		15				.82	10		10										15		15				10		10			15			15								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	007	0		29	10	S7694_007_0	4	Generic	2	010000	1	1	2	1		110	01		110	1				30		90	1	2				30		90	30		31											3.55	17		17				2.15	12		12										17		17				12		12			17			17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	007	0		29	10	S7694_007_0	4	Preferred Brand	2	000001	1	1	3	1		110	01		110	1				30		90	1	2				30		90	30		31											83.52	25		25				50.11	15		15										25		25				15		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	007	0		29	10	S7694_007_0	4	Non-Preferred Drug	2	100100	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											48.57	46		46				34.84	33		33										46		46				33		33			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	007	0		29	10	S7694_007_0	4	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				30								30			30		31											605.02	25						605.02	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	008	0		29	10	S7694_008_0	4	Preferred Generic	3	001000	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								14.90		44.70					1.00		3.00											14.90		44.70				1.00		2.00				14.90				14.90			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	008	0		29	10	S7694_008_0	4	Generic	3	010000	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		45.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	008	0		29	10	S7694_008_0	4	Preferred Brand	3	010001	1	1	3	1		110	01		110	1				30		90	1	2				30		90	30		31											57.40	20		20				28.70	10		10										20		20				10		10			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	008	0		29	10	S7694_008_0	4	Non-Preferred Drug	3	100100	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											56.35	39		39				36.12	25		25										39		39				25		25			39			39								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	008	0		29	10	S7694_008_0	4	Specialty Tier	3	010010	1	1	5	1		010	01		010	1				30								30			30		31											735.38	27						735.38	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	009	0		29	10	S7694_009_0	4	Preferred Generic	3	001000	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								14.90		44.70					1.00		3.00											14.90		44.70				1.00		2.00				14.90				14.90			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	009	0		29	10	S7694_009_0	4	Generic	3	010000	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		45.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	009	0		29	10	S7694_009_0	4	Preferred Brand	3	010001	1	1	3	1		110	01		110	1				30		90	1	2				30		90	30		31											55.54	20		20				27.77	10		10										20		20				10		10			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	009	0		29	10	S7694_009_0	4	Non-Preferred Drug	3	100100	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											48.63	35		35				34.73	25		25										35		35				25		25			35			35								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	009	0		29	10	S7694_009_0	4	Specialty Tier	3	010010	1	1	5	1		010	01		010	1				30								30			30		31											625.45	27						625.45	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	010	0		29	10	S7694_010_0	4	Preferred Generic	3	001000	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								14.90		44.70					1.00		3.00											14.90		44.70				1.00		2.00				14.90				14.90			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	010	0		29	10	S7694_010_0	4	Generic	3	010000	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		45.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	010	0		29	10	S7694_010_0	4	Preferred Brand	3	010001	1	1	3	1		110	01		110	1				30		90	1	2				30		90	30		31											56.01	20		20				28.00	10		10										20		20				10		10			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	010	0		29	10	S7694_010_0	4	Non-Preferred Drug	3	100100	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											50.95	36		36				35.38	25		25										36		36				25		25			36			36								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	010	0		29	10	S7694_010_0	4	Specialty Tier	3	010010	1	1	5	1		010	01		010	1				30								30			30		31											652.15	27						652.15	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	011	0		29	10	S7694_011_0	4	Preferred Generic	2	001000	1	1	1	1		110	01		110	1				30		90	1	2				30		90	30		31											1.19	15		15				.75	10		10										15		15				10		10			15			15								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	011	0		29	10	S7694_011_0	4	Generic	2	010000	1	1	2	1		110	01		110	1				30		90	1	2				30		90	30		31											3.09	17		17				2.01	12		12										17		17				12		12			17			17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	011	0		29	10	S7694_011_0	4	Preferred Brand	2	000001	1	1	3	1		110	01		110	1				30		90	1	2				30		90	30		31											91.92	25		25				55.15	15		15										25		25				15		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	011	0		29	10	S7694_011_0	4	Non-Preferred Drug	2	100100	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											88.94	50		50				58.70	33		33										50		50				33		33			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	011	0		29	10	S7694_011_0	4	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				30								30			30		31											666.10	25						666.10	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	012	0		29	10	S7694_012_0	4	Preferred Generic	2	001000	1	1	1	1		110	01		110	1				30		90	1	2				30		90	30		31											1.21	15		15				.74	10		10										15		15				10		10			15			15								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	012	0		29	10	S7694_012_0	4	Generic	2	010000	1	1	2	1		110	01		110	1				30		90	1	2				30		90	30		31											2.70	17		17				1.89	12		12										17		17				12		12			17			17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	012	0		29	10	S7694_012_0	4	Preferred Brand	2	000001	1	1	3	1		110	01		110	1				30		90	1	2				30		90	30		31											86.98	25		25				52.19	15		15										25		25				15		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	012	0		29	10	S7694_012_0	4	Non-Preferred Drug	2	100100	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											53.22	50		50				40.45	38		38										50		50				38		38			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	012	0		29	10	S7694_012_0	4	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				30								30			30		31											739.89	25						739.89	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	014	0		29	10	S7694_014_0	4	Preferred Generic	3	001000	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								14.90		44.70					1.00		3.00											14.90		44.70				1.00		2.00				14.90				14.90			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	014	0		29	10	S7694_014_0	4	Generic	3	010000	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		45.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	014	0		29	10	S7694_014_0	4	Preferred Brand	3	010001	1	1	3	1		110	01		110	1				30		90	1	2				30		90	30		31											55.70	20		20				27.85	10		10										20		20				10		10			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	014	0		29	10	S7694_014_0	4	Non-Preferred Drug	3	100100	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											44.42	32		32				33.32	24		24										32		32				24		24			32			32								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	014	0		29	10	S7694_014_0	4	Specialty Tier	3	010010	1	1	5	1		010	01		010	1				30								30			30		31											921.02	27						921.02	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	015	0		29	10	S7694_015_0	4	Preferred Generic	2	001000	1	1	1	1		110	01		110	1				30		90	1	2				30		90	30		31											1.35	15		15				.78	10		10										15		15				10		10			15			15								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	015	0		29	10	S7694_015_0	4	Generic	2	010000	1	1	2	1		110	01		110	1				30		90	1	2				30		90	30		31											3.05	17		17				2.08	12		12										17		17				12		12			17			17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	015	0		29	10	S7694_015_0	4	Preferred Brand	2	000001	1	1	3	1		110	01		110	1				30		90	1	2				30		90	30		31											82.28	25		25				49.37	15		15										25		25				15		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	015	0		29	10	S7694_015_0	4	Non-Preferred Drug	2	100100	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											54.27	50		50				37.99	35		35										50		50				35		35			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	015	0		29	10	S7694_015_0	4	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				30								30			30		31											684.79	25						684.79	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	016	0		29	10	S7694_016_0	4	Preferred Generic	2	001000	1	1	1	1		110	01		110	1				30		90	1	2				30		90	30		31											1.25	15		15				.76	10		10										15		15				10		10			15			15								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	016	0		29	10	S7694_016_0	4	Generic	2	010000	1	1	2	1		110	01		110	1				30		90	1	2				30		90	30		31											3.10	17		17				2.08	12		12										17		17				12		12			17			17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	016	0		29	10	S7694_016_0	4	Preferred Brand	2	000001	1	1	3	1		110	01		110	1				30		90	1	2				30		90	30		31											91.15	25		25				54.69	15		15										25		25				15		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	016	0		29	10	S7694_016_0	4	Non-Preferred Drug	2	100100	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											46.78	44		44				35.09	33		33										44		44				33		33			44			44								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	016	0		29	10	S7694_016_0	4	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				30								30			30		31											848.71	25						848.71	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	017	0		29	10	S7694_017_0	4	Preferred Generic	2	001000	1	1	1	1		110	01		110	1				30		90	1	2				30		90	30		31											1.43	15		15				.75	10		10										15		15				10		10			15			15								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	017	0		29	10	S7694_017_0	4	Generic	2	010000	1	1	2	1		110	01		110	1				30		90	1	2				30		90	30		31											3.46	17		17				2.03	12		12										17		17				12		12			17			17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	017	0		29	10	S7694_017_0	4	Preferred Brand	2	000001	1	1	3	1		110	01		110	1				30		90	1	2				30		90	30		31											77.98	25		25				46.79	15		15										25		25				15		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	017	0		29	10	S7694_017_0	4	Non-Preferred Drug	2	100100	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											51.84	49		49				34.91	33		33										49		49				33		33			49			49								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	017	0		29	10	S7694_017_0	4	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				30								30			30		31											650.94	25						650.94	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	018	0		29	10	S7694_018_0	4	Preferred Generic	2	001000	1	1	1	1		110	01		110	1				30		90	1	2				30		90	30		31											1.18	15		15				.75	10		10										15		15				10		10			15			15								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	018	0		29	10	S7694_018_0	4	Generic	2	010000	1	1	2	1		110	01		110	1				30		90	1	2				30		90	30		31											2.97	17		17				1.96	12		12										17		17				12		12			17			17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	018	0		29	10	S7694_018_0	4	Preferred Brand	2	000001	1	1	3	1		110	01		110	1				30		90	1	2				30		90	30		31											90.11	25		25				54.07	15		15										25		25				15		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	018	0		29	10	S7694_018_0	4	Non-Preferred Drug	2	100100	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											58.11	50		50				41.84	36		36										50		50				36		36			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	018	0		29	10	S7694_018_0	4	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				30								30			30		31											775.32	25						775.32	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	019	0		29	10	S7694_019_0	4	Preferred Generic	2	001000	1	1	1	1		110	01		110	1				30		90	1	2				30		90	30		31											.99	15		15				.67	10		10										15		15				10		10			15			15								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	019	0		29	10	S7694_019_0	4	Generic	2	010000	1	1	2	1		110	01		110	1				30		90	1	2				30		90	30		31											2.45	17		17				1.76	12		12										17		17				12		12			17			17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	019	0		29	10	S7694_019_0	4	Preferred Brand	2	000001	1	1	3	1		110	01		110	1				30		90	1	2				30		90	30		31											90.06	25		25				54.04	15		15										25		25				15		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	019	0		29	10	S7694_019_0	4	Non-Preferred Drug	2	100100	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											51.79	47		47				42.97	39		39										47		47				39		39			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	019	0		29	10	S7694_019_0	4	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				30								30			30		31											771.04	25						771.04	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	020	0		29	10	S7694_020_0	4	Preferred Generic	2	001000	1	1	1	1		110	01		110	1				30		90	1	2				30		90	30		31											0.97	15		15				0.59	10		10										15		15				10		10			15			15								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	020	0		29	10	S7694_020_0	4	Generic	2	010000	1	1	2	1		110	01		110	1				30		90	1	2				30		90	30		31											2.55	17		17				1.82	12		12										17		17				12		12			17			17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	020	0		29	10	S7694_020_0	4	Preferred Brand	2	000001	1	1	3	1		110	01		110	1				30		90	1	2				30		90	30		31											77.30	25		25				46.38	15		15										25		25				15		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	020	0		29	10	S7694_020_0	4	Non-Preferred Drug	2	100100	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											71.38	45		45				52.35	33		33										45		45				33		33			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	020	0		29	10	S7694_020_0	4	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				30								30			30		31											701.20	25						701.20	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	021	0		29	10	S7694_021_0	4	Preferred Generic	2	001000	1	1	1	1		110	01		110	1				30		90	1	2				30		90	30		31											1.13	15		15				.77	10		10										15		15				10		10			15			15								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	021	0		29	10	S7694_021_0	4	Generic	2	010000	1	1	2	1		110	01		110	1				30		90	1	2				30		90	30		31											2.95	17		17				1.90	12		12										17		17				12		12			17			17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	021	0		29	10	S7694_021_0	4	Preferred Brand	2	000001	1	1	3	1		110	01		110	1				30		90	1	2				30		90	30		31											84.13	25		25				50.48	15		15										25		25				15		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	021	0		29	10	S7694_021_0	4	Non-Preferred Drug	2	100100	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											51.14	50		50				36.82	36		36										50		50				36		36			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	021	0		29	10	S7694_021_0	4	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				30								30			30		31											668.02	25						668.02	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	022	0		29	10	S7694_022_0	4	Preferred Generic	2	001000	1	1	1	1		110	01		110	1				30		90	1	2				30		90	30		31											1.26	15		15				.72	10		10										15		15				10		10			15			15								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	022	0		29	10	S7694_022_0	4	Generic	2	010000	1	1	2	1		110	01		110	1				30		90	1	2				30		90	30		31											3.09	17		17				1.95	12		12										17		17				12		12			17			17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	022	0		29	10	S7694_022_0	4	Preferred Brand	2	000001	1	1	3	1		110	01		110	1				30		90	1	2				30		90	30		31											85.86	25		25				51.51	15		15										25		25				15		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	022	0		29	10	S7694_022_0	4	Non-Preferred Drug	2	100100	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											57.62	48		48				43.21	36		36										48		48				36		36			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	022	0		29	10	S7694_022_0	4	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				30								30			30		31											734.83	25						734.83	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	023	0		29	10	S7694_023_0	4	Preferred Generic	2	001000	1	1	1	1		110	01		110	1				30		90	1	2				30		90	30		31											1.04	15		15				.68	10		10										15		15				10		10			15			15								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	023	0		29	10	S7694_023_0	4	Generic	2	010000	1	1	2	1		110	01		110	1				30		90	1	2				30		90	30		31											2.78	17		17				2.02	12		12										17		17				12		12			17			17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	023	0		29	10	S7694_023_0	4	Preferred Brand	2	000001	1	1	3	1		110	01		110	1				30		90	1	2				30		90	30		31											87.83	25		25				52.70	15		15										25		25				15		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	023	0		29	10	S7694_023_0	4	Non-Preferred Drug	2	100100	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											58.10	50		50				46.48	40		40										50		50				40		40			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	023	0		29	10	S7694_023_0	4	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				30								30			30		31											863.97	25						863.97	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	024	0		29	10	S7694_024_0	4	Preferred Generic	2	001000	1	1	1	1		110	01		110	1				30		90	1	2				30		90	30		31											1.18	15		15				.75	10		10										15		15				10		10			15			15								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	024	0		29	10	S7694_024_0	4	Generic	2	010000	1	1	2	1		110	01		110	1				30		90	1	2				30		90	30		31											2.88	17		17				1.96	12		12										17		17				12		12			17			17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	024	0		29	10	S7694_024_0	4	Preferred Brand	2	000001	1	1	3	1		110	01		110	1				30		90	1	2				30		90	30		31											88.15	25		25				52.89	15		15										25		25				15		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	024	0		29	10	S7694_024_0	4	Non-Preferred Drug	2	100100	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											57.44	50		50				42.51	37		37										50		50				37		37			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	024	0		29	10	S7694_024_0	4	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				30								30			30		31											762.05	25						762.05	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	025	0		29	10	S7694_025_0	4	Preferred Generic	2	001000	1	1	1	1		110	01		110	1				30		90	1	2				30		90	30		31											1.19	15		15				.74	10		10										15		15				10		10			15			15								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	025	0		29	10	S7694_025_0	4	Generic	2	010000	1	1	2	1		110	01		110	1				30		90	1	2				30		90	30		31											2.95	17		17				1.92	12		12										17		17				12		12			17			17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	025	0		29	10	S7694_025_0	4	Preferred Brand	2	000001	1	1	3	1		110	01		110	1				30		90	1	2				30		90	30		31											87.52	25		25				52.51	15		15										25		25				15		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	025	0		29	10	S7694_025_0	4	Non-Preferred Drug	2	100100	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											53.82	47		47				37.79	33		33										47		47				33		33			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	025	0		29	10	S7694_025_0	4	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				30								30			30		31											756.78	25						756.78	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	026	0		29	10	S7694_026_0	4	Preferred Generic	2	001000	1	1	1	1		110	01		110	1				30		90	1	2				30		90	30		31											1.04	15		15				.72	10		10										15		15				10		10			15			15								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	026	0		29	10	S7694_026_0	4	Generic	2	010000	1	1	2	1		110	01		110	1				30		90	1	2				30		90	30		31											2.67	17		17				2.11	12		12										17		17				12		12			17			17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	026	0		29	10	S7694_026_0	4	Preferred Brand	2	000001	1	1	3	1		110	01		110	1				30		90	1	2				30		90	30		31											83.68	25		25				50.21	15		15										25		25				15		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	026	0		29	10	S7694_026_0	4	Non-Preferred Drug	2	100100	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											52.73	48		48				39.55	36		36										48		48				36		36			48			48								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	026	0		29	10	S7694_026_0	4	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				30								30			30		31											960.83	25						960.83	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	027	0		29	10	S7694_027_0	4	Preferred Generic	2	001000	1	1	1	1		110	01		110	1				30		90	1	2				30		90	30		31											1.02	15		15				.67	10		10										15		15				10		10			15			15								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	027	0		29	10	S7694_027_0	4	Generic	2	010000	1	1	2	1		110	01		110	1				30		90	1	2				30		90	30		31											3.01	17		17				1.89	12		12										17		17				12		12			17			17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	027	0		29	10	S7694_027_0	4	Preferred Brand	2	000001	1	1	3	1		110	01		110	1				30		90	1	2				30		90	30		31											84.05	25		25				50.43	15		15										25		25				15		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	027	0		29	10	S7694_027_0	4	Non-Preferred Drug	2	100100	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											57.24	47		47				40.19	33		33										47		47				33		33			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	027	0		29	10	S7694_027_0	4	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				30								30			30		31											868.79	25						868.79	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	028	0		29	10	S7694_028_0	4	Preferred Generic	2	001000	1	1	1	1		110	01		110	1				30		90	1	2				30		90	30		31											1.36	15		15				.67	10		10										15		15				10		10			15			15								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	028	0		29	10	S7694_028_0	4	Generic	2	010000	1	1	2	1		110	01		110	1				30		90	1	2				30		90	30		31											3.14	17		17				1.95	12		12										17		17				12		12			17			17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	028	0		29	10	S7694_028_0	4	Preferred Brand	2	000001	1	1	3	1		110	01		110	1				30		90	1	2				30		90	30		31											86.00	25		25				51.60	15		15										25		25				15		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	028	0		29	10	S7694_028_0	4	Non-Preferred Drug	2	100100	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											42.73	45		45				31.34	33		33										45		45				33		33			45			45								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	028	0		29	10	S7694_028_0	4	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				30								30			30		31											626.25	25						626.25	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	029	0		29	10	S7694_029_0	4	Preferred Generic	2	001000	1	1	1	1		110	01		110	1				30		90	1	2				30		90	30		31											1.24	15		15				.75	10		10										15		15				10		10			15			15								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	029	0		29	10	S7694_029_0	4	Generic	2	010000	1	1	2	1		110	01		110	1				30		90	1	2				30		90	30		31											3.08	17		17				1.96	12		12										17		17				12		12			17			17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	029	0		29	10	S7694_029_0	4	Preferred Brand	2	000001	1	1	3	1		110	01		110	1				30		90	1	2				30		90	30		31											90.77	25		25				54.46	15		15										25		25				15		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	029	0		29	10	S7694_029_0	4	Non-Preferred Drug	2	100100	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											58.80	50		50				39.98	34		34										50		50				34		34			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	029	0		29	10	S7694_029_0	4	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				30								30			30		31											784.97	25						784.97	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	030	0		29	10	S7694_030_0	4	Preferred Generic	3	001000	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								14.90		44.70					1.00		3.00											14.90		44.70				1.00		2.00				14.90				14.90			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	030	0		29	10	S7694_030_0	4	Generic	3	010000	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		45.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	030	0		29	10	S7694_030_0	4	Preferred Brand	3	010001	1	1	3	1		110	01		110	1				30		90	1	2				30		90	30		31											58.06	20		20				29.03	10		10										20		20				10		10			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	030	0		29	10	S7694_030_0	4	Non-Preferred Drug	3	100100	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											64.29	42		42				38.27	25		25										42		42				25		25			42			42								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	030	0		29	10	S7694_030_0	4	Specialty Tier	3	010010	1	1	5	1		010	01		010	1				30								30			30		31											775.49	27						775.49	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	031	0		29	10	S7694_031_0	4	Preferred Generic	2	001000	1	1	1	1		110	01		110	1				30		90	1	2				30		90	30		31											1.13	15		15				.72	10		10										15		15				10		10			15			15								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	031	0		29	10	S7694_031_0	4	Generic	2	010000	1	1	2	1		110	01		110	1				30		90	1	2				30		90	30		31											2.87	17		17				1.93	12		12										17		17				12		12			17			17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	031	0		29	10	S7694_031_0	4	Preferred Brand	2	000001	1	1	3	1		110	01		110	1				30		90	1	2				30		90	30		31											88.24	25		25				52.95	15		15										25		25				15		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	031	0		29	10	S7694_031_0	4	Non-Preferred Drug	2	100100	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											60.51	47		47				42.49	33		33										47		47				33		33			47			47								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	031	0		29	10	S7694_031_0	4	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				30								30			30		31											684.79	25						684.79	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	032	0		29	10	S7694_032_0	4	Preferred Generic	2	001000	1	1	1	1		110	01		110	1				30		90	1	2				30		90	30		31											1.59	15		15				0.87	10		10										15		15				10		10			15			15								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	032	0		29	10	S7694_032_0	4	Generic	2	010000	1	1	2	1		110	01		110	1				30		90	1	2				30		90	30		31											3.71	17		17				2.31	12		12										17		17				12		12			17			17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	032	0		29	10	S7694_032_0	4	Preferred Brand	2	000001	1	1	3	1		110	01		110	1				30		90	1	2				30		90	30		31											86.00	25		25				51.60	15		15										25		25				15		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	032	0		29	10	S7694_032_0	4	Non-Preferred Drug	2	100100	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											69.25	50		50				47.09	34		34										50		50				34		34			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	032	0		29	10	S7694_032_0	4	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				30								30			30		31											760.21	25						760.21	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	033	0		29	10	S7694_033_0	4	Preferred Generic	2	001000	1	1	1	1		110	01		110	1				30		90	1	2				30		90	30		31											1.02	15		15				.62	10		10										15		15				10		10			15			15								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	033	0		29	10	S7694_033_0	4	Generic	2	010000	1	1	2	1		110	01		110	1				30		90	1	2				30		90	30		31											2.51	17		17				1.61	12		12										17		17				12		12			17			17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	033	0		29	10	S7694_033_0	4	Preferred Brand	2	000001	1	1	3	1		110	01		110	1				30		90	1	2				30		90	30		31											74.33	25		25				44.60	15		15										25		25				15		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	033	0		29	10	S7694_033_0	4	Non-Preferred Drug	2	100100	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											41.86	43		43				32.13	33		33										43		43				33		33			43			43								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	033	0		29	10	S7694_033_0	4	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				30								30			30		31											642.52	25						642.52	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	034	0		29	10	S7694_034_0	4	Preferred Generic	2	001000	1	1	1	1		110	01		110	1				30		90	1	2				30		90	30		31											1.61	15		15				.52	10		10										15		15				10		10			15			15								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	034	0		29	10	S7694_034_0	4	Generic	2	010000	1	1	2	1		110	01		110	1				30		90	1	2				30		90	30		31											3.62	17		17				1.36	12		12										17		17				12		12			17			17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	034	0		29	10	S7694_034_0	4	Preferred Brand	2	000001	1	1	3	1		110	01		110	1				30		90	1	2				30		90	30		31											81.90	25		25				49.14	15		15										25		25				15		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	034	0		29	10	S7694_034_0	4	Non-Preferred Drug	2	100100	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											33.87	46		46				24.30	33		33										46		46				33		33			46			46								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	034	0		29	10	S7694_034_0	4	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				30								30			30		31											572.30	25						572.30	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	070	0		29	10	S7694_070_0	4	Preferred Generic	3	001000	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								14.90		44.70					1.00		3.00											14.90		44.70				1.00		2.00				14.90				14.90			0.50	0.03		0.50	0.03	0.48	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	070	0		29	10	S7694_070_0	4	Generic	3	010000	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		45.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	070	0		29	10	S7694_070_0	4	Preferred Brand	3	010001	1	1	3	1		110	01		110	1				30		90	1	2				30		90	30		31											56.46	20		20				28.23	10		10										20		20				10		10			20			20								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	070	0		29	10	S7694_070_0	4	Non-Preferred Drug	3	100100	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											60.81	40		40				38.01	25		25										40		40				25		25			40			40								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	070	0		29	10	S7694_070_0	4	Specialty Tier	3	010010	1	1	5	1		010	01		010	1				30								30			30		31											781.92	27						781.92	27												27						27					27			27								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	105	0		29	10	S7694_105_0	4	Preferred Generic	2	001000	1	1	1	1		110	01		110	1				30		90	1	2				30		90	30		31											1.17	15		15				.78	10		10										15		15				10		10			15			15								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	105	0		29	10	S7694_105_0	4	Generic	2	010000	1	1	2	1		110	01		110	1				30		90	1	2				30		90	30		31											2.93	17		17				2.03	12		12										17		17				12		12			17			17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	105	0		29	10	S7694_105_0	4	Preferred Brand	2	000001	1	1	3	1		110	01		110	1				30		90	1	2				30		90	30		31											98.75	25		25				59.25	15		15										25		25				15		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	105	0		29	10	S7694_105_0	4	Non-Preferred Drug	2	100100	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											62.15	50		50				45.99	37		37										50		50				37		37			50			50								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	105	0		29	10	S7694_105_0	4	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				30								30			30		31											845.58	25						845.58	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	106	0		29	10	S7694_106_0	4	Preferred Generic	2	001000	1	1	1	1		110	01		110	1				30		90	1	2				30		90	30		31											.79	15		15				.49	10		10										15		15				10		10			15			15								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	106	0		29	10	S7694_106_0	4	Generic	2	010000	1	1	2	1		110	01		110	1				30		90	1	2				30		90	30		31											1.99	17		17				1.25	12		12										17		17				12		12			17			17								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	106	0		29	10	S7694_106_0	4	Preferred Brand	2	000001	1	1	3	1		110	01		110	1				30		90	1	2				30		90	30		31											88.06	25		25				52.84	15		15										25		25				15		15			25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	106	0		29	10	S7694_106_0	4	Non-Preferred Drug	2	100100	1	1	4	1		110	01		110	1				30		90	1	2				30		90	30		31											36.40	38		38				31.61	33		33										38		38				33		33			38			38								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S7694	106	0		29	10	S7694_106_0	4	Specialty Tier	2	010010	1	1	5	1		010	01		010	1				30								30			30		31											742.22	25						742.22	25												25						25					25			25								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S8067	001	0		29	10	S8067_001_0	4	Preferred Generic	3	001001	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								7.00		21.00					2.00		6.00											7.00		21.00				2.00		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												
S8067	001	0		29	10	S8067_001_0	4	Generic	3	010001	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		45.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S8067	001	0		29	10	S8067_001_0	4	Preferred Brand	3	000101	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								45.00		135.00					38.00		114.00											45.00		135.00				38.00		114.00				45.00				45.00			1.50	1.27		1.50	1.27	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S8067	001	0		29	10	S8067_001_0	4	Non-Preferred Drug	3	100100	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								95.00		285.00					89.00		267.00											95.00		285.00				89.00		267.00				95.00				95.00			3.17	2.97		3.17	2.97	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S8067	001	0		29	10	S8067_001_0	4	Specialty Tier	3	010010	1	1	5	1		010	01		010	1				30								30			30		31											701.37	33						701.37	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S8067	003	0		29	10	S8067_003_0	3	Preferred Generic	4	001001	1	2	1	1		110	01		110	1				30		90	1	2				30		90	30		31								9.00		27.00					4.00		12.00											9.00		27.00				4.00		12.00				9.00				9.00			0.30	0.13		0.30	0.13	0.29	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S8067	003	0		29	10	S8067_003_0	3	Generic	4	010001	1	2	2	1		110	01		110	1				30		90	1	2				30		90	30		31								20.00		60.00					15.00		45.00											20.00		60.00				15.00		45.00				20.00				20.00			0.67	0.50		0.67	0.50	0.65	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S8067	003	0		29	10	S8067_003_0	3	Preferred Brand	4	000101	1	2	3	1		110	01		110	1				30		90	1	2				30		90	30		31								45.00		135.00					38.00		114.00											45.00		135.00				38.00		114.00				45.00				45.00			1.50	1.27		1.50	1.27	1.45	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S8067	003	0		29	10	S8067_003_0	3	Non-Preferred Drug	4	100100	1	2	4	1		110	01		110	1				30		90	1	2				30		90	30		31								95.00		285.00					89.00		267.00											95.00		285.00				89.00		267.00				95.00				95.00			3.17	2.97		3.17	2.97	3.06	Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
S8067	003	0		29	10	S8067_003_0	3	Specialty Tier	4	010010	1	1	5	1		010	01		010	1				30								30			30		31											450.05	33						450.05	33												33						33					33			33								Preferred Generic, Generic, Preferred Brand, Non-Preferred Drug, Specialty Tier												
